Individual
DR. BERNARD GRUNSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 STEELES RD, BRISTOL, TN 37620-9532
(423) 844-6700
(423) 844-6703
Mailing address
350 STEELES RD, BRISTOL, TN 37620-9532
(423) 844-6700
(423) 844-6703
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD21854
TN
208000000X
Pediatrics Physician
MD21854
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006747531
—
VA
01
—
103I119101
MEDICARE PTAN BRMC
TN
01
—
110162828
MEDICARE RAILROAD
TN
01
—
242839
ANTHEM PROVIDER NUMBER
VA
01
—
3076812
BLUE CROSS TN PROVIDER #
TN
Enumeration date
06/24/2005
Last updated
04/02/2014
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