Provider Demographics
NPI:1225464860
Name:GRIGORYAN ROLAND, GAYANA (DO)
Entity Type:Individual
Prefix:DR
First Name:GAYANA
Middle Name:
Last Name:GRIGORYAN ROLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 W DAVIS ST APT 8303
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5334
Mailing Address - Country:US
Mailing Address - Phone:913-579-4616
Mailing Address - Fax:
Practice Address - Street 1:21898 FM 1314 RD # B
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-7061
Practice Address - Country:US
Practice Address - Phone:281-354-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5561207P00000X
NJ25MB10012400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine