MEDICARE: DR. JORDAN ELYSE GRUBBS M.D.

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	208600000X	Surgery Physician	S9889	TX

General Provider Information

NPI Number	:	1881081982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN ELYSE GRUBBS M.D.

Provider Business Mailing Address
First Line	:	5656 KELLEY ST STE 30S62008
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-1975
Country	:	US
Telephone Number	:	713-566-5098
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 KELLEY ST STE 30S62008
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-1975
Country	:	US
Telephone Number	:	713-566-5098
Fax Number	:

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	08/03/2021

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