Provider Demographics
NPI:1780795930
Name:GRUENEFELDT, ALAN F (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:F
Last Name:GRUENEFELDT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:844 OLD TUNNEL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8524
Mailing Address - Country:US
Mailing Address - Phone:530-274-9762
Mailing Address - Fax:530-273-7255
Practice Address - Street 1:404 AUBURN FOLSOM RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5515
Practice Address - Country:US
Practice Address - Phone:530-885-6221
Practice Address - Fax:530-885-9403
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG69052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G690520Medicaid
CA00G690520Medicaid
00G690520Medicare ID - Type Unspecified
CA00G690523Medicare PIN