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General NPI Number Information
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NPI Number | 1689747602
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Entity Type | Individual
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Provider Name | ALLEN GEORGE GRUBER M.D
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4720 HOEN AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-7867
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Country | US
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Telephone | 707-595-3122
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Fax | 707-843-3102
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Provider Business Mailing Address
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Address Line | 4720 HOEN AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-7867
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Country | US
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Telephone | 707-595-3122
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Fax | 707-843-3102
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G55246
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License Number State | CA
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