Individual
GRANT R GWINUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1095 MARSHALL WAY STE 203, PLACERVILLE, CA 95667-5722
(530) 344-5496
Mailing address
PO BOX 45680, SAN FRANCISCO, CA 94145-0680
(530) 344-5496
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G57154
CA
208D00000X
General Practice Physician
G57154
CA
Other
Enumeration date
11/04/2005
Last updated
07/21/2022
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