Provider Demographics
NPI:1912995895
Name:GRINDSTAFF, GARY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:GRINDSTAFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721A N LEE TREVINO DR STE 103
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4521
Mailing Address - Country:US
Mailing Address - Phone:915-845-5000
Mailing Address - Fax:915-845-5003
Practice Address - Street 1:1721A N LEE TREVINO DR STE 103
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4521
Practice Address - Country:US
Practice Address - Phone:915-845-5000
Practice Address - Fax:915-845-5003
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1465213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4508290001OtherPALMETTO
TX092741002Medicaid
00504EMedicare ID - Type Unspecified
4508290001OtherPALMETTO