Provider Demographics
NPI:1164582375
Name:GRUBB, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:GRUBB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1705 E 19TH ST
Mailing Address - Street 2:400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5405
Mailing Address - Country:US
Mailing Address - Phone:918-756-7110
Mailing Address - Fax:918-742-7332
Practice Address - Street 1:1705 E 19TH ST
Practice Address - Street 2:400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5405
Practice Address - Country:US
Practice Address - Phone:918-756-7110
Practice Address - Fax:918-742-7332
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK10720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100630AMedicaid
OK100100630AMedicaid