MEDICARE: TREVOR GRUBBS M.D., M.S.P.H

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	207P00000X	Emergency Medicine Physician	M-13051	ID

General Provider Information

NPI Number	:	1477748507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR GRUBBS M.D., M.S.P.H

Provider Business Mailing Address
First Line	:	3080 E GENTRY WAY STE 210
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-3013
Country	:	US
Telephone Number	:	208-384-9022
Fax Number	:

Provider Business Practice Location Address
First Line	:	3080 E GENTRY WAY STE 210
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-3013
Country	:	US
Telephone Number	:	208-384-9022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	11/29/2017

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Directions to “ TREVOR GRUBBS M.D., M.S.P.H” Practice Location

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