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General NPI Number Information
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NPI Number | 1235338401
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Entity Type | Organization
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Legal Business Name | MANUEL GRIEGO JR DO PA
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 1201 MAIN ST SUITE P350
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City | DALLAS
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State | TX
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Zip | 75202-3908
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Country | US
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Telephone | 469-621-6662
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 MAIN ST SUITE 905
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City | DALLAS
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State | TX
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Zip | 75202-4014
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Country | US
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Telephone | 214-580-7277
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MANUEL GRIEGO JR.
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Credential | DO
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Telephone | 214-580-7277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F1604
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License Number State | TX
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