Organization
CLARICE GRANDPRE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARICE GRANDPRE MD (OWNER)
(907) 479-8101
Entity
Organization
Contact information
Practice address
995 ELLESMERE DR, FAIRBANKS, AK 99709-5759
(907) 479-8101
Mailing address
PO BOX 84945, FAIRBANKS, AK 99708-4945
(907) 479-8101
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2983
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1610205
—
AK
Enumeration date
06/06/2013
Last updated
06/03/2014
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