MEDICARE: DR. GABRIELLE J GRUNDY 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
1	207V00000X	Obstetrics & Gynecology Physician	TP332	KY
2	207V00000X	Obstetrics & Gynecology Physician	46455	KY
3	207V00000X	Obstetrics & Gynecology Physician	12405A	WY
4	207V00000X	Obstetrics & Gynecology Physician	20689	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20689	OTHER	NV	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790911238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELLE J GRUNDY MD

Provider Business Mailing Address
First Line	:	6850 N DURANGO DR STE 401
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4598
Country	:	US
Telephone Number	:	702-463-2981
Fax Number	:	702-463-2883

Provider Business Practice Location Address
First Line	:	6850 N DURANGO DR STE 401
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4598
Country	:	US
Telephone Number	:	702-463-2981
Fax Number	:	702-463-2883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	01/06/2025

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