Provider Demographics
NPI:1033104963
Name:GRUBER, EDWARD P (ARNP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:P
Last Name:GRUBER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2117
Mailing Address - Country:US
Mailing Address - Phone:509-323-7600
Mailing Address - Fax:509-323-7602
Practice Address - Street 1:829 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2117
Practice Address - Country:US
Practice Address - Phone:509-323-7600
Practice Address - Fax:509-323-7602
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9628694Medicaid
WAAB17677Medicare ID - Type Unspecified
WA9628694Medicaid