Provider Demographics
NPI:1578619102
Name:WILFREDO GRANA, M.D.,P.C.
Entity Type:Organization
Organization Name:WILFREDO GRANA, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-238-8109
Mailing Address - Street 1:230 E 10TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5764
Mailing Address - Country:US
Mailing Address - Phone:256-238-8109
Mailing Address - Fax:256-238-8183
Practice Address - Street 1:230 E 10TH ST STE 206
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5764
Practice Address - Country:US
Practice Address - Phone:256-238-8109
Practice Address - Fax:256-238-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1427120054OtherWISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION
ALP00301079OtherRAILROAD MEDICARE
AL1427120054Medicaid
ALDE5655OtherRAILROAD MEDICARE
AL1427120054OtherTRICARE FOR LIFE
AL51003605OtherBLUE CROSS AND BLUE SHIELD OF ALABAMA
AL1427120054Medicaid
AL051557247Medicare PIN