Provider Demographics
NPI:1972003069
Name:GRANGER, STEPHEN (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GRANGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 650859
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0859
Mailing Address - Country:US
Mailing Address - Phone:918-582-1980
Mailing Address - Fax:918-561-1289
Practice Address - Street 1:6465 S SHORE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5528
Practice Address - Country:US
Practice Address - Phone:918-582-1980
Practice Address - Fax:918-561-1289
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT0795207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine