Provider Demographics
NPI:1396951521
Name:ALAN W GRUNING DO & ASSOCIATES PA
Entity type:Organization
Organization Name:ALAN W GRUNING DO & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRUNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-629-9700
Mailing Address - Street 1:PO BOX 7151
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7151
Mailing Address - Country:US
Mailing Address - Phone:941-629-9700
Mailing Address - Fax:941-629-5800
Practice Address - Street 1:4535 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2930
Practice Address - Country:US
Practice Address - Phone:941-629-9700
Practice Address - Fax:941-629-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5181208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82989OtherBLUE CROSS BLUE SHIELD
OH13652141400OtherWORKMENS COMPENSATION
FL1932190519OtherDR GRUNING NPI
FL1497746804OtherMARY L HARDEN NPI
FL5174118OtherAETNA
FL=========OtherFLORIDA EIN
FL82989VMedicare PIN
FL1932190519OtherDR GRUNING NPI
FL5174118OtherAETNA