Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC26728 | CA |
NPI | 1295933182 |
---|---|
Provider Name | Dr. Timothy Lee Grund |
First Address | Santa Rosa, CA 95404-1538 |
Second Address | Santa Rosa, CA 95405-4761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 07/08/2013 |