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General NPI Number Information
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NPI Number | 1245599497
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Entity Type | Organization
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Legal Business Name | STEPHEN E. GRABLE, M.D., P.A.
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 1504 ROBERTS DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3222
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Country | US
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Telephone | 904-247-7455
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Fax | 904-247-8550
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Provider Business Mailing Address
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Address Line | 1504 ROBERTS DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3222
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Country | US
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Telephone | 904-247-7455
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Fax | 904-247-8550
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN E. GRABLE
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Credential | M.D.
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Telephone | 904-247-7455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0056718
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License Number State | FL
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