MEDICARE: DR. HEATHER NORRIS GRANADO 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	207P00000X	Emergency Medicine Physician	P1848	TX

General Provider Information

NPI Number	:	1568697589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER NORRIS GRANADO DO

Provider Business Mailing Address
First Line	:	1313 COLORADO DR
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-4229
Country	:	US
Telephone Number	:	817-366-2515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 SW WILSHIRE BLVD
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-8338
Country	:	US
Telephone Number	:	817-366-2515
Fax Number	:

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

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	11/10/2015

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