Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | AZ15336 | AZ |
NPI | 1003963679 |
---|---|
Provider Name | William D Grainger |
First Address | Chandler, AZ 85224-5901 |
Second Address | Gilbert, AZ 85234-5012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 30/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D36942 | (02) | AZ |