Healthcare Provider Details

I. General information

NPI: 1902812944
Provider Name (Legal Business Name): THOMAS W. GRABOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 31ST ST
HONDO TX
78861-3512
US

IV. Provider business mailing address

PO BOX 167
HELOTES TX
78023-0167
US

V. Phone/Fax

Practice location:
  • Phone: 830-741-3361
  • Fax: 830-426-8496
Mailing address:
  • Phone: 210-382-6217
  • Fax: 210-451-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberE4364
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: