MEDICARE: RONALD GRUBMAN PA

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1285039446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD GRUBMAN PA

Provider Business Mailing Address
First Line	:	5429 LBJ FWY
Second Line	:	STE 850
City	:	DALLAS
State	:	TX
Zip	:	75240-2607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W GRAND AVE
Second Line	:	STE 90
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3275
Country	:	US
Telephone Number	:	256-459-4987
Fax Number	:	256-459-4980

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

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	10/30/2014

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