Provider Demographics
NPI:1164432506
Name:GRIEGO, ENRIQUE J (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:J
Last Name:GRIEGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1683
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1630
Mailing Address - Country:US
Mailing Address - Phone:956-687-6667
Mailing Address - Fax:
Practice Address - Street 1:1900 S JACKSON RD STE 9
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1589
Practice Address - Country:US
Practice Address - Phone:956-687-6667
Practice Address - Fax:956-618-1075
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030912201Medicaid
TX742871470OtherTAX ID
TX8F20788OtherMEDICARE PTAN
TXG50524Medicare UPIN