Provider Demographics
NPI:1033317870
Name:GRANGER, JEREMY JULIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JULIAN
Last Name:GRANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 SUNNYBROOK DR STE E100
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4250
Mailing Address - Country:US
Mailing Address - Phone:712-266-2700
Mailing Address - Fax:712-266-2666
Practice Address - Street 1:5885 SUNNYBROOK DR STE E100
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4250
Practice Address - Country:US
Practice Address - Phone:712-266-2700
Practice Address - Fax:712-266-2666
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25311208000000X
IAMD-43860208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics