Individual
MARK A GRANRUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
215 E HAWAII AVENUE, NAMPA, ID 83686
(208) 463-3000
(208) 463-3034
Mailing address
217 W GEORGIA, SUITE 115, NAMPA, ID 83686
(208) 463-3000
(208) 463-3034
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA621
ID
Other
Enumeration date
02/27/2006
Last updated
07/08/2007
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