NPI 1205809852 · live from the CMS NPI Registry
Brian E Granvall, PA-C
Radiology, Diagnostic Radiology in Boise, ID. National Provider Identifier 1205809852, active.
NPI record
| NPI | 1205809852 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 190 E Bannock St, Boise, ID 83712 |
| Practice phone | 208-381-2094 |
| Mailing address | Po Box 1108, Corvallis, OR 97339 |
| Enumerated | February 13, 2006 |
| Last updated | January 31, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 0110002940 (VA) |
| Physician Assistant | 363A00000X | PA10004399 (WA) |
| Physician Assistant | 363A00000X | PA 00846 (OR) |
| Physician Assistant, Surgical | 363AS0400X | C04233 (MD) |
| Radiology, Diagnostic Radiology primary | 2085R0202X | PA-1042 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.