MEDICARE: ELMA GRANADO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	G9744	TX
2	2084P0804X	Child & Adolescent Psychiatry Physician	G9744	TX
3	2084P0800X	Psychiatry Physician	G9744	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00600823	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8U1294	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1215980644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELMA GRANADO MD

Provider Business Mailing Address
First Line	:	PO BOX 99335
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76199-0335
Country	:	US
Telephone Number	:	817-927-3638
Fax Number	:	817-923-8769

Provider Business Practice Location Address
First Line	:	855 MONTGOMERY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2553
Country	:	US
Telephone Number	:	817-927-3638
Fax Number	:	817-923-8769

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/03/2026

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Directions to “ ELMA GRANADO MD” Practice Location

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