Provider Demographics
NPI:1427040856
Name:GRANDA, ENRIQUE B JR (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:B
Last Name:GRANDA
Suffix:JR
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8200 WEDNESBURY LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2925
Mailing Address - Country:US
Mailing Address - Phone:713-988-0104
Mailing Address - Fax:713-988-1838
Practice Address - Street 1:8200 WEDNESBURY LN
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2925
Practice Address - Country:US
Practice Address - Phone:713-988-0104
Practice Address - Fax:713-988-1838
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE1858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R605Medicare ID - Type Unspecified
TXE24111Medicare UPIN