Provider Demographics
NPI:1942401617
Name:EDWARD B GRIPON MD PA
Entity Type:Organization
Organization Name:EDWARD B GRIPON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRIPON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-899-4472
Mailing Address - Street 1:3560 DELAWARE ST
Mailing Address - Street 2:STE 502
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3067
Mailing Address - Country:US
Mailing Address - Phone:409-899-4472
Mailing Address - Fax:409-899-9795
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 502
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:409-899-4472
Practice Address - Fax:409-899-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD50202084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23138Medicare UPIN