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NPI Code Detail

MEDICARE: JEFFREY SCOTT GRUNER M.D.

MEDICARE: JEFFREY SCOTT GRUNER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician023672LA
22086S0102XSurgical Critical Care Physician77713AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00012293OTHERLARAILROAD MEDICARE PIN#
7DA0978OTHERLARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2900070463GROTHERLAOSCHNER
41700784OTHERLAUNITED HEALTHCARE
5195344OTHERLACOVENTRY
67194459OTHERLAAETNA

General Provider Information

NPI Number : 1073515862
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY SCOTT GRUNER M.D.
Provider Business Mailing Address
First Line : 7777 HENNESSY BLVD STE 102
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-4363
Country : US
Telephone Number : 225-765-2048
Fax Number : 225-765-1958
Provider Business Practice Location Address
First Line : 1200 N BEAVER ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-3118
Country : US
Telephone Number : 928-773-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/17/2025

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Directions to “ JEFFREY SCOTT GRUNER M.D.” Practice Location

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