Healthcare Provider Details

I. General information

NPI: 1831652148
Provider Name (Legal Business Name): CHRISTOPHER SLOAN GRUBB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 FAIRMOUNT AVE
FORT WORTH TX
76104-4215
US

IV. Provider business mailing address

1201 FAIRMOUNT AVE
FORT WORTH TX
76104-4215
US

V. Phone/Fax

Practice location:
  • Phone: 817-335-5288
  • Fax: 817-338-0927
Mailing address:
  • Phone: 817-335-5288
  • Fax: 817-338-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberU1024
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberU1024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: