Individual
J. GRANT HORMELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2612 PLEASANT VALLEY BLVD, ALTOONA, PA 16602-4420
(814) 944-9355
(814) 696-0808
Mailing address
2612 PLEASANT VALLEY BLVD, ALTOONA, PA 16602-4420
(814) 944-9355
(814) 696-0808
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD040654L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012449780006
—
PA
Enumeration date
07/26/2005
Last updated
03/03/2008
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