Provider Demographics
NPI:1689672784
Name:GRUBB, STEPHEN D (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:GRUBB
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 1:111 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6502
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:3600 SEA MOUNTAIN HIGWAY
Practice Address - Street 2:SUITE C
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566
Practice Address - Country:US
Practice Address - Phone:843-399-4848
Practice Address - Fax:910-653-2346
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22475207Q00000X
SC7841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC561243962OtherBCBS
NC0363OtherCIGNA MEDICARE
NC890291HMedicaid
SCE16113Medicaid
NC5950176Medicaid
NC2315069OtherCIGNA MEDICARE
NC5950653Medicaid
SC570941629OtherBCBS
NCCA9980OtherRAILROAD MEDICARE
NCCA9980OtherRAILROAD MEDICARE
SCE16113Medicaid
NC2315069OtherCIGNA MEDICARE
SC4770OtherSC MEDICARE
NC5950176Medicaid