Basic Information
| Provider Information | |||||||||
| NPI: | 1124094487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANGER | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 WEEKS DR | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275733929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365985480 | ||||||||
| FaxNumber: | 3365985482 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 WEEKS DR | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275733929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365985480 | ||||||||
| FaxNumber: | 3365985482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 04/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 25298 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 36728 | 01 | NC | BCBS | OTHER | 8936728 | 05 | NC | MEDICAID |