Provider Demographics
NPI:1427120054
Name:GRANA, WILFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:GRANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DEERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-1030
Mailing Address - Country:US
Mailing Address - Phone:256-835-6122
Mailing Address - Fax:256-238-8183
Practice Address - Street 1:230 E 10TH ST STE 206
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5764
Practice Address - Country:US
Practice Address - Phone:256-238-8109
Practice Address - Fax:256-238-8183
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL11275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051557247Medicare PIN
ALC78848Medicare UPIN