Healthcare Provider Details

I. General information

NPI: 1225569635
Provider Name (Legal Business Name): JOHN CALEB GRENN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1820
US

IV. Provider business mailing address

1521 S STAPLES ST STE 606
CORPUS CHRISTI TX
78404-3166
US

V. Phone/Fax

Practice location:
  • Phone: 877-832-2652
  • Fax: 877-454-6896
Mailing address:
  • Phone: 877-832-2652
  • Fax: 361-371-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV9000
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberV9000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: