Provider Demographics
NPI:1346230380
Name:GRUNDEN, FRED E (CRNA)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:E
Last Name:GRUNDEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 8 BOX 665
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-9498
Mailing Address - Country:US
Mailing Address - Phone:409-384-6544
Mailing Address - Fax:409-384-9359
Practice Address - Street 1:RR 8 BOX 665
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-9498
Practice Address - Country:US
Practice Address - Phone:409-384-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234517207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032172OtherRECERTIFICATION CRNA
TX88286HMedicare ID - Type Unspecified
TXR57199Medicare UPIN