Provider Demographics
NPI:1932168069
Name:GRANGER, JOHN KENT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENT
Last Name:GRANGER
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:P.O. BOX 51917
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206
Mailing Address - Country:US
Mailing Address - Phone:940-383-2223
Mailing Address - Fax:
Practice Address - Street 1:1500 INTERSTATE 35W
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207
Practice Address - Country:US
Practice Address - Phone:940-383-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6117207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118291701Medicaid
TX118291706Medicaid
TX118291705Medicaid
TX118291707Medicaid
TX118291701Medicaid
TX8L14393Medicare PIN
TX118291707Medicaid
TX118291705Medicaid
TX8L14479Medicare PIN