Individual
DR. GRANT T FANKHAUSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9192 W UNION HILLS DR, PEORIA, AZ 85382-8208
(602) 374-4101
(602) 441-0522
Mailing address
9192 W UNION HILLS DR, PEORIA, AZ 85382-8208
(602) 374-4101
(602) 441-0522
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
37503
AZ
2086S0129X
Vascular Surgery Physician
Primary
37503
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
705707
—
AZ
Enumeration date
07/06/2006
Last updated
08/09/2024
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