Healthcare Provider Details

I. General information

NPI: 1053498279
Provider Name (Legal Business Name): CURTIS MICHAEL GRENOBLE P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE SUITE 311
DU BOIS PA
15801-1462
US

IV. Provider business mailing address

145 HOSPITAL AVE SUITE 311
DU BOIS PA
15801-1462
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3750
  • Fax:
Mailing address:
  • Phone: 814-375-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052799
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA002194
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: