MEDICARE: DR. HENRY JACK GRAINGER DO

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	207RC0000X	Cardiovascular Disease Physician	E1595	TX
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	E1595	TX
3	207R00000X	Internal Medicine Physician	E1595	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00R283	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306892005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY JACK GRAINGER DO

Provider Business Mailing Address
First Line	:	511A W TIDWELL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-4338
Country	:	US
Telephone Number	:	713-694-9709
Fax Number	:	281-618-8761

Provider Business Practice Location Address
First Line	:	511A W TIDWELL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-4338
Country	:	US
Telephone Number	:	713-694-9709
Fax Number	:	281-618-8761

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/12/2021

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