Peter Percy Grandaw, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G79712 Issued in CA

Practice address

1892 Buenaventura Blvd
Redding, CA 96001-3761

Phone

(530) 243-9478

Fax

(530) 243-9378

NPI assigned

Aug 28, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228867200000",
    "number": "1013900737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1892 BUENAVENTURA BLVD",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960013761",
            "telephone_number": "530-243-9478",
            "fax_number": "530-243-9378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1892 BUENAVENTURA BLVD",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960013761",
            "telephone_number": "530-243-9478",
            "fax_number": "530-243-9378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDAW",
        "first_name": "PETER",
        "middle_name": "PERCY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-28",
        "last_updated": "2008-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G79712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G797120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Alyssa Graham, FNP-C
• Leah Graham
• Nicole Wanda Graham
• Monica Lee Gralian
• Matthew Grana, D.O.
• Grant Elementary School District
• Gwen Graun, RN
• Susan Kay Graves, PTA
• Angelique Michelle Gray
• Bobbie J. Gray, L.C.S.W.

• Specialist in Redding, CA
• Providers in Redding, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.