Provider Demographics
NPI:1316999865
Name:GRANDGENETT, RYAN L (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:GRANDGENETT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3014
Mailing Address - Street 2:MCFARLAND CLINIC PC 1215 DUFF AVE
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4400
Mailing Address - Fax:515-239-4446
Practice Address - Street 1:1018 DUFF AVE
Practice Address - Street 2:MCFARLAND CLINIC PC
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-663-8621
Practice Address - Fax:515-663-8620
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI44886020207Q00000X
IA37407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1316999865Medicaid
IAI20913Medicare PIN