MEDICARE: JEEWANJOT GREWAL 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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	V3009	TX

General Provider Information

NPI Number	:	1427686096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEEWANJOT GREWAL MD

Provider Business Mailing Address
First Line	:	923 PENNSYLVANIA AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	923 PENNSYLVANIA AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2254
Country	:	US
Telephone Number	:	817-920-0484
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	01/30/2026

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