MEDICARE: STEPHEN E. GRABLE, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0056718	FL

General Provider Information

NPI Number	:	1245599497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN E. GRABLE, M.D., P.A.

Provider Business Mailing Address
First Line	:	1504 ROBERTS DR
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3222
Country	:	US
Telephone Number	:	904-247-7455
Fax Number	:	904-247-8550

Provider Business Practice Location Address
First Line	:	1504 ROBERTS DR
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3222
Country	:	US
Telephone Number	:	904-247-7455
Fax Number	:	904-247-8550

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN E. GRABLE
Credential	:	M.D.
Telephone Number	:	904-247-7455

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	03/31/2017

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