Basic Information
| Provider Information | |||||||||
| NPI: | 1457354045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRONERT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26666 | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871256666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059236770 | ||||||||
| FaxNumber: | 5059235354 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 CENTRAL AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058411234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2001-200 | NM | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 2001-200 | NM | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP3000X | ME69110 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207LP3000X | 2001-200 | NM | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 80729541 | 05 | CO | MEDICAID | 104477100 | 05 | FL | MEDICAID | 64907 | 05 | NM | MEDICAID | B0966 | 05 | NM | MEDICAID | NM009G13 | 01 | NM | BLUE CROSS BLUE SHEILD | OTHER | 264798 | 01 | MD | MARYLAND DEPT. OF LABOR | OTHER | 1643587 | 05 | TX | MEDICAID | 201029035 | 01 | NM | PHP, SALUD, ETC... | OTHER | 579617 | 05 | AZ | MEDICAID |