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NPI Code Detail

MEDICARE: DR. STEPHEN R GRUBB M.D.

MEDICARE: DR. STEPHEN R GRUBB M.D.
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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician11158WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467462531
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN R GRUBB M.D.
Provider Business Mailing Address
First Line : 3100 MACCORKLE AVE SE STE 205
Second Line :
City : CHARLESTON
State : WV
Zip : 25304-1228
Country : US
Telephone Number : 304-720-7305
Fax Number : 304-720-7310
Provider Business Practice Location Address
First Line : 3100 MACCORKLE AVE SE STE 205
Second Line :
City : CHARLESTON
State : WV
Zip : 25304-1228
Country : US
Telephone Number : 304-720-7305
Fax Number : 304-720-7310
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 07/21/2022

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