Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Lake Granbury Internal Medicine & Pediatrics, PA

Organization Internal Medicine Physician · NPI 1972608636

Lake Granbury Internal Medicine & Pediatrics, PA is an Internal Medicine Physician in Granbury, Texas. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
2
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2005 Rockview Dr
Granbury, TX 76049
Phone: (817) 579-1005
Fax: (817) 579-1093
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Pediatrics Physician Taxonomy 208000000X

Record details

NPI number1972608636
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Penelope Jackson — Physician/Owner · (817) 579-1005
NPI enumeratedSeptember 14, 2006
Last updated in NPPESApril 2, 2014
Mailing address2005 Rockview Drive, Granbury, TX 76049

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