Provider Demographics
NPI:1669479747
Name:GRENDYS, EDWARD C JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:GRENDYS
Suffix:JR
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:8931 COLONIAL CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7816
Practice Address - Country:US
Practice Address - Phone:239-334-6626
Practice Address - Fax:239-334-0404
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072182207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2262127-008OtherCIGNA PROVIDER NUMBER
FL3762567OtherAETNA HMO PROVIDER #
FL251462100Medicaid
FL1278212OtherWELLCARE-MEDICARE AND MEDICAID
FLP00194029OtherRAILROAD MEDICARE
FL32707OtherBCBS OF FL. PROVIDER #
FL1046139OtherFIRST HEALTH PROV. NUMBER
FL4521619OtherAETNA OTHER PROVIDER #
FL4521619OtherAETNA OTHER PROVIDER #
FL32707WMedicare PIN