1003963679 NPI number — WILLIAM D GRAINGER MD

Table of content: WILLIAM D GRAINGER MD (NPI 1003963679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003963679 NPI number — WILLIAM D GRAINGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAINGER
Provider First Name:
WILLIAM
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003963679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1343 N ALMA SCHOOL RD
Provider Second Line Business Mailing Address:
STE 160
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85224-5901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-776-2982
Provider Business Mailing Address Fax Number:
480-917-7309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
726 N GREENFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85234-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-834-8885
Provider Business Practice Location Address Fax Number:
480-751-5724
Provider Enumeration Date:
01/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  AZ15336 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)