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 1:6900 DANIELS PKWY STE 29-173
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7513
Mailing Address - Country:US
Mailing Address - Phone:239-939-3303
Mailing Address - Fax:
Practice Address - Street 1:13450 PARKER COMMONS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1834
Practice Address - Country:US
Practice Address - Phone:239-939-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV3602207Q00000X
NC202401664207Q00000X
KSTW00530207Q00000X
FLOS5181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60787Medicare UPIN
FL82989VMedicare ID - Type Unspecified