Individual
JUAN PABLO GRIMALDOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4054
(682) 885-7497
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
L4406
TX
207L00000X
Anesthesiology Physician
ME85392
FL
207LP3000X
Pediatric Anesthesiology Physician
Primary
L4406
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137345809
MEDICAID GROUP NUMBER
TX
01
—
140442853
CSHCN GROUP NUMBER
TX
01
—
152965304
CSHCN
TX
05
—
152965305
—
TX
01
—
152965306
CSHCN
TX
05
—
271316100
—
FL
Enumeration date
06/27/2006
Last updated
04/04/2012
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