Provider Demographics
NPI:1629177837
Name:GRUBER, SCOTT ERIC (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ERIC
Last Name:GRUBER
Suffix:
Gender:M
Credentials:DPM
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 121
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-0121
Mailing Address - Country:US
Mailing Address - Phone:610-826-7332
Mailing Address - Fax:610-824-6564
Practice Address - Street 1:171 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1708
Practice Address - Country:US
Practice Address - Phone:610-826-7332
Practice Address - Fax:610-824-6564
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002731L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0984716Medicaid
PA50001390OtherCAPITAL BLUE CROSS
PA50001391OtherCAPITAL BLUE CROSS
PA50001390OtherCAPITAL BLUE CROSS
PA148381Medicare ID - Type Unspecified