Provider Demographics
NPI:1669688693
Name:DEGER, GRANT E (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:E
Last Name:DEGER
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:PO BOX 41123
Mailing Address - Street 2:MS 41123
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98504-1123
Mailing Address - Country:US
Mailing Address - Phone:360-725-8700
Mailing Address - Fax:360-586-9060
Practice Address - Street 1:7345 LINDERSON WAY SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6504
Practice Address - Country:US
Practice Address - Phone:360-725-8700
Practice Address - Fax:360-586-9060
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine