Individual
DR. LAURENCE SHANE GRUNDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2330 UTAH AVE STE 200, EL SEGUNDO, CA 90245-4817
(281) 766-0959
Mailing address
2700 UNIVERSITY SQUARE DRIVE, RADIOLOGY ASSOCIATES OF TAMPA, TAMPA, FL 33612-5513
(813) 251-5822
(813) 254-4597
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
ME71962
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME71962
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118774
—
AL
05
—
261385900
—
FL
Enumeration date
03/23/2006
Last updated
02/18/2025
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