Provider Demographics
NPI:1114243466
Name:LAURA A GRUNEIRO MD PA
Entity Type:Organization
Organization Name:LAURA A GRUNEIRO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-620-7053
Mailing Address - Street 1:18316 MURDOCK CIR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1008
Mailing Address - Country:US
Mailing Address - Phone:507-620-7053
Mailing Address - Fax:
Practice Address - Street 1:18316 MURDOCK CIR
Practice Address - Street 2:SUITE 107
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1008
Practice Address - Country:US
Practice Address - Phone:507-620-7053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME868272086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty