Provider Demographics
NPI:1932190519
Name:GRUNING, ALAN W (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:W
Last Name:GRUNING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:239-939-3303
Mailing Address - Fax:
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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60787Medicare UPIN
FL82989VMedicare ID - Type Unspecified