MEDICARE: DR. JOHN ANTHONY GRAGNANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	35494	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962499236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANTHONY GRAGNANI M.D.

Provider Business Mailing Address
First Line	:	1510 SCOFIELD VALLEY LN
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63038-1349
Country	:	US
Telephone Number	:	636-458-4350
Fax Number	:	636-458-4350

Provider Business Practice Location Address
First Line	:	1510 SCOFIELD VALLEY LN
Second Line	:
City	:	WILDWOOD
State	:	MO
Zip	:	63038-1349
Country	:	US
Telephone Number	:	636-458-4350
Fax Number	:	636-458-4350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	01/18/2024

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