Provider Demographics
NPI:1629078241
Name:GRUBBS, PHILIP E (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:E
Last Name:GRUBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 DAVIS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7013
Mailing Address - Country:US
Mailing Address - Phone:540-951-8885
Mailing Address - Fax:540-951-8887
Practice Address - Street 1:817 DAVIS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7013
Practice Address - Country:US
Practice Address - Phone:540-951-8885
Practice Address - Fax:540-951-8887
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-11-22
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
VA0101051261208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006900241Medicaid