Provider Demographics
NPI:1134162605
Name:GRANBERRY, WILLIAM MALCOLM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MALCOLM
Last Name:GRANBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-790-1818
Mailing Address - Fax:713-790-7500
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-790-1818
Practice Address - Fax:713-790-7500
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2412207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4105814OtherAETNA/US HEALTHCARE
TX741660214OtherHEALTH NEW ENGLAND
TX200016150OtherMEDICARE RAILROAD
TX6570151OtherCIGNA
TX1371569-05Medicaid
TX843087OtherBCBS OF TEXAS
TXE32881Medicare UPIN
TX741660214OtherHEALTH NEW ENGLAND