Provider Demographics
NPI:1033113469
Name:GRUGLE, THOMAS ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALBERT
Last Name:GRUGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12830 HILLCREST RD STE D222
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1527
Mailing Address - Country:US
Mailing Address - Phone:469-250-1340
Mailing Address - Fax:844-710-6013
Practice Address - Street 1:12801 N CENTRAL EXPY STE 350
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1732
Practice Address - Country:US
Practice Address - Phone:469-250-1340
Practice Address - Fax:844-710-6013
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG81532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K61GMedicare PIN
B23158Medicare UPIN
B23158Medicare UPIN