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Individual

MR. ALAN J GRENKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
2800 E AJO WAY, TUCSON, AZ 85713-6204
(520) 874-4921
Mailing address
2826 E 10TH ST, TUCSON, AZ 85716-5209
(520) 393-8234

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3748
AZ
363A00000X
Physician Assistant
Primary
PA-854
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
329420
STATE AHCCCS
AZ
05
Z121868
AZ
Enumeration date
08/05/2006
Last updated
07/31/2009
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