Individual
JACOB STUART GRANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1032 E JACKSON ST, MEDFORD, OR 97504
(541) 770-4559
(541) 770-4511
Mailing address
1032 E JACKSON ST, MEDFORD, OR 97504-7027
(541) 770-4559
(541) 770-4511
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD186209
OR
390200000X
Student in an Organized Health Care Education/Training Program
0116026086
VA
Other
Enumeration date
04/17/2013
Last updated
06/19/2018
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