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Individual
MARK A GRANNER
Active
Individual
MARK A GRANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
Primary
MD-29194
IA
2084N0400X
Neurology Physician
29194
IA
2084N0600X
Clinical Neurophysiology Physician
MD-29194
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11900
WELLMARK BCBS
IA
Enumeration date
08/24/2005
Last updated
04/28/2025
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