MEDICARE: DR. MANUEL GRIEGO JR. D.O.

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	207Q00000X	Family Medicine Physician	F1604	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528170206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL GRIEGO JR. D.O.

Provider Business Mailing Address
First Line	:	700 N PEARL ST
Second Line	:	SUITE N510
City	:	DALLAS
State	:	TX
Zip	:	75201-2824
Country	:	US
Telephone Number	:	214-580-7277
Fax Number	:	214-580-7283

Provider Business Practice Location Address
First Line	:	2701 S HAMPTON RD
Second Line	:	SUITE 101
City	:	DALLAS
State	:	TX
Zip	:	75224-2367
Country	:	US
Telephone Number	:	214-330-9221
Fax Number	:	214-580-7283

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/27/2018

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