Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME 0038592 | FL |
NPI | 1255398798 |
---|---|
Provider Name | Dr. Christopher Joel Grainger |
First Address | Ocala, FL 34474-5752 |
Second Address | Ocala, FL 34474-5752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 22/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065707700 | (05) | FL |
D85735 | (02) | FL |