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NPI Code Detail

MEDICARE: BRIAN A GRUS MD

MEDICARE: BRIAN A GRUS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician101019MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053421065
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN A GRUS MD
Provider Business Mailing Address
First Line : 20 PROGRESS POINT PKWY STE 108
Second Line :
City : O FALLON
State : MO
Zip : 63368-2207
Country : US
Telephone Number : 636-344-2400
Fax Number :
Provider Business Practice Location Address
First Line : 20 PROGRESS POINT PKWY STE 108
Second Line :
City : O FALLON
State : MO
Zip : 63368-2207
Country : US
Telephone Number : 636-344-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 02/19/2021

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Directions to “ BRIAN A GRUS MD” Practice Location

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