Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 25298 | NC |
NPI | 1124094487 |
---|---|
Provider Name | Ronald Eugene Granger |
First Address | Roxboro, NC 27573-3929 |
Second Address | Roxboro, NC 27573-3929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 09/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36728 | BCBS (01) | NC |
8936728 | (05) | NC |
C8673 | (02) |