MEDICARE: DR. ENRIQUE B GRANDA JR. M.D.,P.A.

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	207R00000X	Internal Medicine Physician	E1858	TX

General Provider Information

NPI Number	:	1427040856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENRIQUE B GRANDA JR. M.D.,P.A.

Provider Business Mailing Address
First Line	:	8200 WEDNESBURY LN
Second Line	:	SUITE 102
City	:	HOUSTON
State	:	TX
Zip	:	77074-2925
Country	:	US
Telephone Number	:	713-988-0104
Fax Number	:	713-988-1838

Provider Business Practice Location Address
First Line	:	8200 WEDNESBURY LN
Second Line	:	SUITE 102
City	:	HOUSTON
State	:	TX
Zip	:	77074-2925
Country	:	US
Telephone Number	:	713-988-0104
Fax Number	:	713-988-1838

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	02/08/2008

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Directions to “ DR. ENRIQUE B GRANDA JR. M.D.,P.A.” Practice Location

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