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Individual

MR. FREDERIC GRANNIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1500 E DUARTE RD, DUARTE, CA 91010
(626) 359-8111
Mailing address
1333 S. MAYFLOWER AVE., 2ND FLOOR, MONROVIA, CA 91016-4066
(626) 775-3514
(626) 408-3911

Taxonomy

Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
G36693
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
G36693
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G386930
CA
Enumeration date
08/04/2006
Last updated
08/11/2015
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