1396748349 NPI number — DR. GEORGE M GRUNERT M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	GRUNERT
Provider First Name	:	GEORGE
Provider Middle Name	:	M
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	M.D.
Provider Gender Code	:	M

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1396748349
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	01/22/2009
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	7900 FANNIN ST
Provider Second Line Business Mailing Address	:	SUITE 4400
Provider Business Mailing Address City Name	:	HOUSTON
Provider Business Mailing Address State Name	:	TX
Provider Business Mailing Address Postal Code	:	770542900
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	7135127000
Provider Business Mailing Address Fax Number	:	7135127082

Provider First Line Business Practice Location Address	:	7900 FANNIN ST
Provider Second Line Business Practice Location Address	:	SUITE 4400
Provider Business Practice Location Address City Name	:	HOUSTON
Provider Business Practice Location Address State Name	:	TX
Provider Business Practice Location Address Postal Code	:	770542900
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	7135127000
Provider Business Practice Location Address Fax Number	:	7135127082
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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Authorized Official Title or Position	:
Authorized Official Telephone Number	:

• Taxonomy code: 207VE0102X , with the licence number:  E0945 , registered in the state of TX .

• Identifier: 84380J . This is a "FT.BEND/MONT" identifier , issued by the state of ( TX ) . This identifiers is of the category "".
• Identifier: B23159 , issued by the state of ( TX ) . This identifiers is of the category "".
• Identifier: 84325J . This is a "BRAZORIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "".
• Identifier: 83047G . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "".
• Identifier: 84282J . This is a "HARRIS COUNTY" identifier , issued by the state of ( TX ) . This identifiers is of the category "".