Provider Demographics
NPI:1255462917
Name:GLORIA RODARTE BRUN, M. D., P. A.
Entity type:Organization
Organization Name:GLORIA RODARTE BRUN, M. D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:RODARTE
Authorized Official - Last Name:BRUN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:903-454-9404
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ68902084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0356321-01Medicaid
TX0356321-01Medicaid