Provider Demographics
NPI:1023091014
Name:GRUN, TANYA RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:RENEE
Last Name:GRUN
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 1:301 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:830-620-7744
Mailing Address - Fax:
Practice Address - Street 1:1220 RIVER BEND DR STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5073
Practice Address - Country:US
Practice Address - Phone:800-465-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135125609Medicaid
TX8F21450OtherMEDICARE USER#
TXOOY940OtherGROUP PTAN #
TX8F7698OtherINDIVIDUAL PTAN #
TX8F21450OtherMEDICARE USER#
TX135125609Medicaid