Provider Demographics
NPI:1821292152
Name:GREWALL, JATINDER PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JATINDER
Middle Name:PAUL
Last Name:GREWALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7014 N WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0155
Mailing Address - Country:US
Mailing Address - Phone:559-321-2858
Mailing Address - Fax:559-321-2780
Practice Address - Street 1:7014 N WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0155
Practice Address - Country:US
Practice Address - Phone:559-321-2858
Practice Address - Fax:559-321-2780
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99543208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00424398OtherRAILROAD MEDICARE
CAP00424398OtherRAILROAD MEDICARE