Provider Demographics
NPI:1285837682
Name:JAY L GRUHLKEY MD PA
Entity Type:Organization
Organization Name:JAY L GRUHLKEY MD PA
Other - Org Name:LONESTAR MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRUHLKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-626-9911
Mailing Address - Street 1:301 MAIN PLZ # 342
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5136
Mailing Address - Country:US
Mailing Address - Phone:830-626-9911
Mailing Address - Fax:830-626-9922
Practice Address - Street 1:952 GRUENE RD STE 150
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3920
Practice Address - Country:US
Practice Address - Phone:830-626-9911
Practice Address - Fax:830-626-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH00248Medicare UPIN