Provider Demographics
NPI:1053306407
Name:GRUMBERG, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GRUMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 PEGGY LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5708
Mailing Address - Country:US
Mailing Address - Phone:972-272-3502
Mailing Address - Fax:972-205-0544
Practice Address - Street 1:2231 PEGGY LN
Practice Address - Street 2:SUITE 1
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5708
Practice Address - Country:US
Practice Address - Phone:972-272-3502
Practice Address - Fax:972-205-0544
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8498208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00TV42OtherBCBS
F58947Medicare UPIN