Provider Demographics
NPI:1306831086
Name:RICHARD L. GRANDJEAN, M.D., P.A.
Entity Type:Organization
Organization Name:RICHARD L. GRANDJEAN, M.D., P.A.
Other - Org Name:RAINTREE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:GRANDJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-327-3333
Mailing Address - Street 1:997 RAINTREE CIR STE 150
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4954
Mailing Address - Country:US
Mailing Address - Phone:214-327-3333
Mailing Address - Fax:877-448-0543
Practice Address - Street 1:997 RAINTREE CIR STE 150
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4954
Practice Address - Country:US
Practice Address - Phone:214-327-3333
Practice Address - Fax:877-448-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E04220Medicare UPIN
TXB110226Medicare PIN