Healthcare Provider Details

I. General information

NPI: 1104825850
Provider Name (Legal Business Name): MARC PAUL GRENIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MANATEE AVE W SUITE 202
BRADENTON FL
34205-8604
US

IV. Provider business mailing address

701 MANATEE AVE W SUITE 202
BRADENTON FL
34205-8604
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2455
  • Fax: 941-746-4554
Mailing address:
  • Phone: 941-748-2455
  • Fax: 941-746-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME0037353
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: