Provider Demographics
NPI:1831121532
Name:FANKHAUSER, GRANT T (MD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:T
Last Name:FANKHAUSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9192 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8208
Mailing Address - Country:US
Mailing Address - Phone:602-374-4101
Mailing Address - Fax:602-441-0522
Practice Address - Street 1:9192 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8208
Practice Address - Country:US
Practice Address - Phone:602-374-4101
Practice Address - Fax:602-441-0522
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ37503208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ705707Medicaid
AZ705707Medicaid