Provider Demographics
NPI:1417088154
Name:BRUN, GLORIA RODARTE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:RODARTE
Last Name:BRUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 WESLEY ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6326
Mailing Address - Country:US
Mailing Address - Phone:903-454-9404
Mailing Address - Fax:903-454-2129
Practice Address - Street 1:5604 WESLEY ST
Practice Address - Street 2:STE. 101
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6326
Practice Address - Country:US
Practice Address - Phone:903-454-9404
Practice Address - Fax:903-454-2129
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ68902084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0356321-01Medicaid
TX162037OtherVALUE OPTIONS
TX00R62BMedicare UPIN
TX00R62BMedicare PIN