Provider Demographics
NPI:1306892005
Name:GRAINGER, HENRY JACK (DO)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JACK
Last Name:GRAINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511A W TIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-4338
Mailing Address - Country:US
Mailing Address - Phone:713-694-9709
Mailing Address - Fax:281-618-8761
Practice Address - Street 1:511A W TIDWELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-4338
Practice Address - Country:US
Practice Address - Phone:713-694-9709
Practice Address - Fax:281-618-8761
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1595207RC0000X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R283OtherBLUE CROSS BLUE SHIELD
TX115814904Medicaid
TXD75135Medicare UPIN