Provider Demographics
NPI:1518926351
Name:GRUBBS, GERALD E (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
Last Name:GRUBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6600 UNIVERSITY PKWY
Mailing Address - Street 2:STE 102
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9040
Mailing Address - Country:US
Mailing Address - Phone:941-378-3231
Mailing Address - Fax:941-378-3253
Practice Address - Street 1:600 N CATTLEMEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6422
Practice Address - Country:US
Practice Address - Phone:941-378-3231
Practice Address - Fax:941-378-3253
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME639732085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25248UOtherMEDICARE INDIVIDUAL PROVIDER I.D.
F79345Medicare UPIN
FL25248UOtherMEDICARE INDIVIDUAL PROVIDER I.D.