Healthcare Provider Details

I. General information

NPI: 1629078241
Provider Name (Legal Business Name): PHILIP E GRUBBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

817 DAVIS ST SUITE 2
BLACKSBURG VA
24060-7013
US

IV. Provider business mailing address

817 DAVIS ST SUITE 2
BLACKSBURG VA
24060-7013
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-8885
  • Fax: 540-951-8887
Mailing address:
  • Phone: 540-951-8885
  • Fax: 540-951-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101051261
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: