Individual
DR. RENEE E GRANDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
603 MEDICAL PARKWAY, ENTERPRISE, OR 97828-1168
(541) 426-4502
(541) 426-6403
Mailing address
603 MEDICAL PARKWAY, ENTERPRISE, OR 97828-1168
(541) 426-4502
(541) 426-6403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD23645
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286848
—
OR
01
—
5966015
BCBS
OR
01
—
80184662
RAILROAD MEDICARE
OR
01
—
J054902
PACIFIC SOURCE
OK
Enumeration date
08/23/2005
Last updated
08/08/2012
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