Individual
DR. TIMOTHY S GRANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4052 PIONEER PKWY, SUITE 208, SALT LAKE CITY, UT 84120-2062
(801) 955-1232
(801) 955-1543
Mailing address
4052 PIONEER PKWY, SUITE 208, SALT LAKE CITY, UT 84120-2062
(801) 955-1232
(801) 955-1543
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
891801521205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
891801521205
UTAH STATE ID
UT
Enumeration date
03/27/2006
Last updated
07/03/2009
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