1518926351 NPI number — DR. GERALD E GRUBBS M.D.

Table of content: DR. GERALD E GRUBBS M.D. (NPI 1518926351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518926351 NPI number — DR. GERALD E GRUBBS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUBBS
Provider First Name:
GERALD
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518926351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 UNIVERSITY PKWY
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
LAKEWOOD RANCH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34240-9040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-378-3231
Provider Business Mailing Address Fax Number:
941-378-3253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N CATTLEMEN RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34232-6422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-378-3231
Provider Business Practice Location Address Fax Number:
941-378-3253
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME63973 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD61413006 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: ME63973 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25248U . This is a "MEDICARE INDIVIDUAL PROVIDER I.D." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 101198300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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