Individual
DR. BERNARD GRUNSTRA
Active
Individual
DR. BERNARD GRUNSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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