Provider Demographics
NPI:1609825165
Name:GRANGER, SHAWN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PATRICK
Last Name:GRANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4614
Mailing Address - Country:US
Mailing Address - Phone:337-392-2330
Mailing Address - Fax:337-392-2580
Practice Address - Street 1:908 S 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4614
Practice Address - Country:US
Practice Address - Phone:337-392-2330
Practice Address - Fax:337-392-2580
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11865R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1499862Medicaid
LA1499862Medicaid
LAI51545Medicare UPIN