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Individual
JACOB STUART GRANGE
Active
Individual
JACOB STUART GRANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD186209
OR
390200000X
Student in an Organized Health Care Education/Training Program
0116026086
VA
Other
Enumeration date
04/17/2013
Last updated
06/19/2018
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