| Edward B Gripon Md Pa | |
|
3560 Delaware St Suite 502 Beaumont TX 77706-3067 | |
| (409) 899-4472 | |
| (409) 899-9795 |
| Full Name | Edward B Gripon Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3560 Delaware St, Beaumont, Texas |
| Authorized Official Name and Position | Edward B Gripon (DOCTOR) |
| Authorized Official Contact | 4098994472 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward B Gripon Md Pa 3560 Delaware St Ste 502 Beaumont TX 77706-3067 Ph: (409) 899-4472 | Edward B Gripon Md Pa 3560 Delaware St Suite 502 Beaumont TX 77706-3067 Ph: (409) 899-4472 |
| NPI Number | 1942401617 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 07/10/2012 |
| Medicare PECOS PAC ID | 3577729102 |
|---|---|
| Medicare Enrollment ID | O20120725000600 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942401617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0015X | Psychiatry & Neurology - Psychosomatic Medicine | D5020 (Texas) | Primary |
| Provider Name | Lera Susan Kasseroler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821032665 PECOS PAC ID: 8820038730 Enrollment ID: I20050510001144 |
| Provider Name | Edward B Gripon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063411775 PECOS PAC ID: 2466618095 Enrollment ID: I20120725000622 |
| Provider Name | Christopher S Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295158368 PECOS PAC ID: 3971726217 Enrollment ID: I20140514000995 |
| Provider Name | Taylor Michael Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194213025 PECOS PAC ID: 8224430715 Enrollment ID: I20210706003501 |
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