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General NPI Number Information
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NPI Number | 1942401617
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Entity Type | Organization
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Legal Business Name | EDWARD B GRIPON MD PA
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 3560 DELAWARE ST SUITE 502
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City | BEAUMONT
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State | TX
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Zip | 77706-3067
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Country | US
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Telephone | 409-899-4472
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Fax | 409-899-9795
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Provider Business Mailing Address
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Address Line | 3560 DELAWARE ST STE 502
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City | BEAUMONT
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State | TX
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Zip | 77706-3067
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Country | US
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Telephone | 409-899-4472
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Fax | 409-899-9795
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. EDWARD B GRIPON
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Credential | M.D.
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Telephone | 409-899-4472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | D5020
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License Number State | TX
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