MEDICARE: STEPHEN E GRABLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME56718	FL

General Provider Information

NPI Number	:	1003837659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN E GRABLE MD

Provider Business Mailing Address
First Line	:	1504 ROBERTS DRIVE
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250
Country	:	US
Telephone Number	:	904-247-7455
Fax Number	:	904-247-8550

Provider Business Practice Location Address
First Line	:	1504 ROBERTS DRIVE
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250
Country	:	US
Telephone Number	:	904-247-7455
Fax Number	:	904-247-8550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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