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Organization

GRANGER MEDICAL CLINIC PC

Active
Parent organization
GRANGER MEDICAL CLINIC PC
Other names
Granger Medical Draper
Organization subpart
Yes

Provider details

NPI number
Legal business name
GRANGER MEDICAL CLINIC PC
Authorized official
MARY JANE PENNINGTON (PRESIDENT)
(801) 965-3600
Entity
Organization

Contact information

Practice address
11724 SOUTH STATE ST., DRAPER, UT 84020
(801) 965-3600
(801) 965-3740
Mailing address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3600

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician
207RG0100X
Gastroenterology Physician
207RN0300X
Nephrology Physician
207RP1001X
Pulmonary Disease Physician
207RS0010X
Sports Medicine (Internal Medicine) Physician
207RS0012X
Sleep Medicine (Internal Medicine) Physician
207V00000X
Obstetrics & Gynecology Physician
207W00000X
Ophthalmology Physician
207X00000X
Orthopaedic Surgery Physician
207Y00000X
Otolaryngology Physician
208000000X
Pediatrics Physician
208200000X
Plastic Surgery Physician
208VP0000X
Pain Medicine Physician

Other

Enumeration date
05/06/2013
Last updated
12/13/2023
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