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General NPI Number Information
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NPI Number | 1750720637
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Entity Type | Individual
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Provider Name | BRIDGET GRUENDER MD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2013
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 2614 FORUM BLVD STE 100
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City | COLUMBIA
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State | MO
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Zip | 65203-5431
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Country | US
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Telephone | 573-445-5366
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Fax | 573-313-3571
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Provider Business Mailing Address
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Address Line | 2614 FORUM BLVD STE 100
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City | COLUMBIA
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State | MO
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Zip | 65203-5431
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Country | US
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Telephone | 573-445-5366
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Fax | 573-313-3571
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2013017865
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2014022140
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License Number State | MO
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