Provider Demographics
NPI:1740011816
Name:JENNINGS, GRAYSON MATTHEW I
Entity type:Individual
Prefix:MR
First Name:GRAYSON
Middle Name:MATTHEW
Last Name:JENNINGS
Suffix:I
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 1:119 CINNAMON OAK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7305
Mailing Address - Country:US
Mailing Address - Phone:832-720-2709
Mailing Address - Fax:
Practice Address - Street 1:119 CINNAMON OAK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7305
Practice Address - Country:US
Practice Address - Phone:832-720-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program