Provider Demographics
NPI:1881695542
Name:GRUNSPAN, AVIE AVSHALOM (MD)
Entity type:Individual
Prefix:DR
First Name:AVIE
Middle Name:AVSHALOM
Last Name:GRUNSPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 POND HILL ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231
Mailing Address - Country:US
Mailing Address - Phone:210-249-5020
Mailing Address - Fax:210-572-1540
Practice Address - Street 1:4114 POND HILL ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231
Practice Address - Country:US
Practice Address - Phone:210-249-5020
Practice Address - Fax:210-572-1540
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6407207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1584468-04Medicaid
TX8F21479Medicare PIN