Provider Demographics
NPI:1508811449
Name:BRIAN K . GRANGER, M.D. APMC
Entity Type:Organization
Organization Name:BRIAN K . GRANGER, M.D. APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-264-1291
Mailing Address - Street 1:600 E GLORIA SWITCH RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-2512
Mailing Address - Country:US
Mailing Address - Phone:337-264-1291
Mailing Address - Fax:337-235-0852
Practice Address - Street 1:600 E GLORIA SWITCH RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-2512
Practice Address - Country:US
Practice Address - Phone:337-264-1291
Practice Address - Fax:337-235-0852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022624173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty