Individual
DR. HENRY JACK GRAINGER
Active
Individual
DR. HENRY JACK GRAINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
E1595
TX
207RC0000X
Cardiovascular Disease Physician
E1595
TX
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
E1595
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R283
BLUE CROSS BLUE SHIELD
TX
05
—
115814904
—
TX
Enumeration date
05/25/2006
Last updated
04/12/2021
Update your record
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