Provider Demographics
NPI:1245599497
Name:STEPHEN E. GRABLE, M.D., P.A.
Entity Type:Organization
Organization Name:STEPHEN E. GRABLE, M.D., P.A.
Other - Org Name:COMPLEMENTARY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-247-7455
Mailing Address - Street 1:1504 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3222
Mailing Address - Country:US
Mailing Address - Phone:904-247-7455
Mailing Address - Fax:904-247-8550
Practice Address - Street 1:1504 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3222
Practice Address - Country:US
Practice Address - Phone:904-247-7455
Practice Address - Fax:904-247-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE75856Medicare UPIN