Provider Demographics
NPI:1417977125
Name:GRUBB, GREGORY A (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:GRUBB
Suffix:
Gender:M
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-468-0260
Mailing Address - Fax:239-343-4254
Practice Address - Street 1:3501 HEALTH CENTER BLVD STE 2180
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8133
Practice Address - Country:US
Practice Address - Phone:239-343-0260
Practice Address - Fax:239-343-4254
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-079869207Q00000X
FLOS13529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115524000Medicaid
D95482Medicare UPIN