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Individual

NATHAN LEE GRANNEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
401 N KEENE ST, COLUMBIA, MO 65201-6625
(573) 876-1600
(573) 876-1606
Mailing address
401 N KEENE ST, COLUMBIA, MO 65201-6625
(573) 876-1600
(573) 876-1606

Taxonomy

Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
2012023532
MO
2083X0100X
Occupational Medicine Physician
Primary
2012023532
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200008322
MO
Enumeration date
06/22/2011
Last updated
01/08/2024
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