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General NPI Number Information
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NPI Number | 1649505108
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Entity Type | Individual
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Provider Name | GEORGE RONNIE GRUBBS JR. PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 536 SUMMER SAILS DR
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City | VALRICO
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State | FL
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Zip | 33594-8004
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Country | US
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Telephone | 813-789-0552
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Fax |
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Provider Business Mailing Address
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Address Line | 536 SUMMER SAILS DR
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City | VALRICO
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State | FL
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Zip | 33594-8004
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Country | US
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Telephone | 813-662-2307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7985
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License Number State | FL
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