Provider Demographics
NPI:1922240563
Name:TANYA R. GRUN, M.D., P.A.
Entity Type:Organization
Organization Name:TANYA R. GRUN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-279-7690
Mailing Address - Street 1:301 MAIN PLZ # 330
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:830-279-7690
Mailing Address - Fax:830-625-0353
Practice Address - Street 1:652 N HOUSTON AVE STE 2
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4123
Practice Address - Country:US
Practice Address - Phone:830-279-7690
Practice Address - Fax:830-625-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E52670Medicare UPIN