Provider Demographics
NPI:1114122124
Name:GRUNER, FRANK M (FRANK GRUNER)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:M
Last Name:GRUNER
Suffix:
Gender:M
Credentials:FRANK GRUNER
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:M
Other - Last Name:GRUNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2675 PALISADES CREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-7553
Mailing Address - Country:US
Mailing Address - Phone:503-349-5502
Mailing Address - Fax:
Practice Address - Street 1:2008 WILLAMETTE FALLS DR STE 200A
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4620
Practice Address - Country:US
Practice Address - Phone:503-607-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist