Provider Demographics
NPI:1528170206
Name:GRIEGO, MANUEL JR (DO)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:GRIEGO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:700 N PEARL ST
Mailing Address - Street 2:SUITE N510
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2824
Mailing Address - Country:US
Mailing Address - Phone:214-580-7277
Mailing Address - Fax:214-580-7283
Practice Address - Street 1:2701 S HAMPTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-2367
Practice Address - Country:US
Practice Address - Phone:214-330-9221
Practice Address - Fax:214-580-7283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF1604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80266201Medicaid
TX8794J1Medicare PIN
TXE26327Medicare UPIN