Individual
JONATHAN L GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
444 FOUR STATES DR, SUITE 1, GALENA, KS 66739-4324
(620) 783-4441
(620) 783-4090
Mailing address
PO BOX 2546, JOPLIN, MO 64803-2546
(620) 783-4441
(620) 783-4090
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0433509
KS
207X00000X
Orthopaedic Surgery Physician
107822
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100404800C
—
KS
05
—
100404800G
—
KS
05
—
207974510
—
MO
Enumeration date
06/27/2006
Last updated
12/30/2011
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