Provider Demographics
NPI:1962499236
Name:GRAGNANI, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:GRAGNANI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1510 SCOFIELD VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63038-1349
Mailing Address - Country:US
Mailing Address - Phone:636-458-4350
Mailing Address - Fax:636-458-4350
Practice Address - Street 1:1510 SCOFIELD VALLEY LN
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63038-1349
Practice Address - Country:US
Practice Address - Phone:636-458-4350
Practice Address - Fax:636-458-4350
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2024-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO35494208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201128915Medicaid