Granvall, Brian E

Granvall, Brian E is an individual health care provider with primary practice located at 190 E Bannock St , Boise ID 83712-6241. He recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Granvall, Brian E can be contacted via phone (208) 381-2094.

Contact Information

Primary practice address
190 E Bannock St Boise ID 83712-6241
Phone: (208) 381-2094
Fax: (208) 381-1791
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0110002940 Virginia
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA10004399 Washington
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA 00846 Oregon
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X C04233 Maryland
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X PA-1042 Idaho

Profile Details

NPI number 1205809852
LBN Legal business name Granvall, Brian E
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2006
Last updated Jan 31st, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205809852 NPPES
Washington MEDICAID 8326142

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