Provider Demographics
NPI:1710985221
Name:COMPREHENSIVE OBSTETRICS AND GYNECOLOGY OF GRANBURY, P.A.
Entity Type:Organization
Organization Name:COMPREHENSIVE OBSTETRICS AND GYNECOLOGY OF GRANBURY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:HOWSER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:817-279-1776
Mailing Address - Street 1:1212 MEDICAL PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5653
Mailing Address - Country:US
Mailing Address - Phone:817-279-1776
Mailing Address - Fax:817-279-7206
Practice Address - Street 1:1212 MEDICAL PLAZA CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5653
Practice Address - Country:US
Practice Address - Phone:817-279-1776
Practice Address - Fax:817-279-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143934101Medicaid
TX00434RMedicare PIN