Karl Daniel Granroth, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3602 Issued in AZ

Practice address

620 Lee St
Winslow, AZ 86047-2435

Phone

(928) 289-2000

NPI assigned

Mar 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237248000000",
    "number": "1639294739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-213-6121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 LEE ST",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860472435",
            "telephone_number": "928-289-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANROTH",
        "first_name": "KARL",
        "middle_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2009-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3602",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "3602",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Winslow, AZ
• Providers in Winslow, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; 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.