Basic Information
| Provider Information | |||||||||
| NPI: | 1033317870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANGER | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | JULIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5885 SUNNYBROOK DR STE E100 | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122662700 | ||||||||
| FaxNumber: | 7122662666 | ||||||||
| Practice Location | |||||||||
| Address1: | 5885 SUNNYBROOK DR STE E100 | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122662700 | ||||||||
| FaxNumber: | 7122662666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25311 | NE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD-43860 | IA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.