Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD 012104E | PA |
NPI | 1033448725 |
---|---|
Provider Name | Dr. Richard F Grunt |
First Address | Garnet Valley, PA 19060-2206 |
Second Address | Garnet Valley, PA 19060-2206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2009 |
Last Update Date | 09/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B36785 | (02) | PA |