Individual
PER GRANSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2028 E PRINCE RD, TUCSON, AZ 85719-2005
(520) 874-3500
Mailing address
2701 E ELVIRA RD, TUCSON, AZ 85706-7124
(520) 874-3500
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22167
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
299182
—
AZ
01
—
300088215
RAILROAD MEDICARE
AZ
Enumeration date
02/16/2006
Last updated
05/15/2008
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