Individual
JEFFREY SCOTT GRUNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 773-2200
Mailing address
7777 HENNESSY BLVD STE 102, BATON ROUGE, LA 70808-4363
(225) 765-2048
(225) 765-1958
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
023672
LA
2086S0102X
Surgical Critical Care Physician
Primary
77713
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1486795
—
LA
01
—
1700784
UNITED HEALTHCARE
LA
01
—
195344
COVENTRY
LA
01
—
7194459
AETNA
LA
01
—
900070463GR
OSCHNER
LA
01
—
DA0978
RAILROAD MEDICARE
LA
01
—
P00012293
RAILROAD MEDICARE PIN#
LA
Enumeration date
08/11/2005
Last updated
07/17/2025
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