Provider Demographics
NPI:1508897935
Name:GRANNUM, ERROL OLWYN (MD)
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:OLWYN
Last Name:GRANNUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1255
Mailing Address - Country:US
Mailing Address - Phone:956-687-3937
Mailing Address - Fax:956-687-3938
Practice Address - Street 1:1910 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1255
Practice Address - Country:US
Practice Address - Phone:956-687-3937
Practice Address - Fax:956-687-3938
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5972207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG61818Medicare UPIN