Provider Demographics
NPI:1356310908
Name:GRANT, ANDRINE K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRINE
Middle Name:K
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:530 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5006
Practice Address - Country:US
Practice Address - Phone:210-225-4511
Practice Address - Fax:210-225-4514
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL9709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB135853OtherPRINCETON MEDICAL GROUP PA
TX168714701Medicaid
TX8C7578OtherMEDICARE
TXTXB135853OtherPRINCETON MEDICAL GROUP PA