Individual
RYAN GRANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A
Contact information
Practice address
1851 OLD HIGHWAY 66 UNIT 1, EDGEWOOD, NM 87015
(505) 286-2396
(505) 286-2398
Mailing address
12127B HWY 14 N, STE 5, CEDAR CREST, NM 87008-9499
(505) 281-5180
(505) 281-5320
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 2016-0016
NM
Other
Enumeration date
02/12/2016
Last updated
04/14/2016
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