Provider Demographics
NPI:1114487246
Name:GRUBBS, HAILEY (DO)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 W. OAKLAND PARK BOULEVARD
Mailing Address - Street 2:S. 116
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:954-742-0306
Mailing Address - Fax:
Practice Address - Street 1:7800 W. OAKLAND PARK BOULEVARD
Practice Address - Street 2:S. 116
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-742-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20055207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology