Provider Demographics
NPI:1861472110
Name:GRANGER, CHRISTOPHER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LEE
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 1:403 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-5507
Mailing Address - Country:US
Mailing Address - Phone:337-463-8977
Mailing Address - Fax:337-462-3093
Practice Address - Street 1:403 W 8TH ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-5507
Practice Address - Country:US
Practice Address - Phone:337-463-8977
Practice Address - Fax:337-462-3093
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1627062Medicaid
LA1627062Medicaid
LA4J757CR11Medicare PIN