Provider Demographics
NPI:1104825850
Name:GRENIER, MARC PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:PAUL
Last Name:GRENIER
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 1:701 MANATEE AVE W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8604
Mailing Address - Country:US
Mailing Address - Phone:941-748-2455
Mailing Address - Fax:941-746-4554
Practice Address - Street 1:701 MANATEE AVE W
Practice Address - Street 2:SUITE 202
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8604
Practice Address - Country:US
Practice Address - Phone:941-748-2455
Practice Address - Fax:941-746-4554
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037353173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41206OtherBCBS PROVIDER NUMBER
FL624892OtherAETNA PROVIDER NUMBER
FLD54731Medicare UPIN
FL41206ZMedicare ID - Type Unspecified