Provider Demographics
NPI:1588633549
Name:GRUNEIRO, ALEJANDRO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:J
Last Name:GRUNEIRO
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 1:18308 MURDOCK CIR
Mailing Address - Street 2:109
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1008
Mailing Address - Country:US
Mailing Address - Phone:941-625-3411
Mailing Address - Fax:
Practice Address - Street 1:18308 MURDOCK CIR
Practice Address - Street 2:109
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1008
Practice Address - Country:US
Practice Address - Phone:941-625-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421493208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001958256Medicaid
PA071990Medicare ID - Type Unspecified
PA001958256Medicaid