Healthcare Provider Details

I. General information

NPI: 1639255037
Provider Name (Legal Business Name): JAMES CURTIS GRUBBS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S 63RD ST
MESA AZ
85206-1619
US

IV. Provider business mailing address

PO BOX 2358
PAYSON AZ
85547-2358
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-3937
  • Fax:
Mailing address:
  • Phone: 928-472-2311
  • Fax: 928-472-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN059709
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: