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General NPI Number Information
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NPI Number | 1013366962
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Entity Type | Individual
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Provider Name | JUDAH KENNETH GRUEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 5959 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75235-6234
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Country | US
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Telephone | 214-645-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 49 JESSE HILL JR DR SE
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City | ATLANTA
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State | GA
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Zip | 30303-3049
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Country | US
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Telephone | 404-778-1606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 83266
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2016019452
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | T6578
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License Number State | TX
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