Individual
SAM E GRUNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1015 NW 22ND AVE, STE T-240, PORTLAND, OR 97210-3025
(503) 413-7127
(503) 227-0218
Mailing address
PO BOX 3730, DINW#103, PORTLAND, OR 97208-3730
(800) 878-6698
(918) 665-4180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD18027
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051461
—
OR
01
—
300101075
RAILROAD MEDICARE
OR
05
—
8142721
—
WA
05
—
MD1805R
—
AK
Enumeration date
06/11/2006
Last updated
10/17/2011
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