Healthcare Provider Details

I. General information

NPI: 1720081151
Provider Name (Legal Business Name): ANDREW D GRUBBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 EXECUTIVE PARK DR STE 406
CINCINNATI OH
45241-4017
US

IV. Provider business mailing address

PO BOX 632778
CINCINNATI OH
45263-2778
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-6747
  • Fax: 513-563-6988
Mailing address:
  • Phone: 513-891-7574
  • Fax: 513-793-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-049478
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35-049478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: