Provider Demographics
NPI:1871184473
Name:GRIGG, BRANDON STANLEY
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:STANLEY
Last Name:GRIGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12309 DEERBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1002
Mailing Address - Country:US
Mailing Address - Phone:210-965-5300
Mailing Address - Fax:
Practice Address - Street 1:12309 DEERBROOK TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1002
Practice Address - Country:US
Practice Address - Phone:210-965-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care