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NPI Code Detail

MEDICARE: DR. JEANETTE BURGESS GRUBE M.D.

MEDICARE: DR. JEANETTE BURGESS GRUBE M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician13145HI
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician48394CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2021863OTHERCOKAISER COMMERCIAL NUMBER

General Provider Information

NPI Number : 1437129954
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEANETTE BURGESS GRUBE M.D.
Provider Business Mailing Address
First Line : 10350 E DAKOTA AVE
Second Line :
City : DENVER
State : CO
Zip : 80247-1314
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11000 E 45TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80239-3004
Country : US
Telephone Number : 303-338-4545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 06/02/2021

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