Provider Demographics
NPI:1508882812
Name:GRUBB, JESSICA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:GRUBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ANTHEM
Mailing Address - Street 2:220 VIRGINIA AVENUE
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204
Mailing Address - Country:US
Mailing Address - Phone:800-331-1476
Mailing Address - Fax:314-362-9851
Practice Address - Street 1:ANTHEM
Practice Address - Street 2:220 VIRGINIA AVENUE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204
Practice Address - Country:US
Practice Address - Phone:800-331-1476
Practice Address - Fax:314-362-9851
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111018207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO931720183Medicare PIN
MO931720183Medicaid
IL$$$$$$$$$Medicaid
MO207298100Medicaid