Provider Demographics
NPI:1467764811
Name:GREWAL, PRABHJOT KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHJOT
Middle Name:KAUR
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 S. CONROE MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4722
Mailing Address - Country:US
Mailing Address - Phone:936-523-5242
Mailing Address - Fax:936-539-3635
Practice Address - Street 1:605 S. CONROE MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4722
Practice Address - Country:US
Practice Address - Phone:936-523-5242
Practice Address - Fax:936-539-3635
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0037685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine