Gordon Ernest Gruen
Oral and Maxillofacial Pathology
780 Ridge Lake Blvd Suite 101
Memphis
, Tennessee 38120-9426
Gordon Ernest Gruen
Oral and Maxillofacial Pathology
780 Ridge Lake Blvd Suite 101
Memphis
, Tennessee 38120-9426
(901) 682-2345
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About
Features
Specialties
- Oral and Maxillofacial Pathology
Languages spoken
- English
Location
First Address
- Gordon Ernest Gruen
- 780 Ridge Lake Blvd Suite 101
- Memphis, TN
- Zip : 38120-9426
- Fax : (901) 682-2345
- Phone : (901) 682-8431
Second Address
- Gordon Ernest Gruen
- 780 Ridge Lake Blvd Suite 101
- Memphis, TN
- Zip : 38120-9426
- Fax : (901) 682-2345
- Phone : (901) 682-8431
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0106X | Oral and Maxillofacial Pathology | DS 1783 | TN |
National Provider Identifier
| NPI | 1629183116 |
|---|---|
| Provider Name | Gordon Ernest Gruen |
| First Address | Memphis, TN 38120-9426 |
| Second Address | Memphis, TN 38120-9426 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/08/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 2007914 | BLUE CROSS BLUE SHIELD (01) | TN |
| T74116 | (02) | TN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.