Provider Demographics
NPI:1689747602
Name:GRUBER, ALLEN GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:GEORGE
Last Name:GRUBER
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 1:4720 HOEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7867
Mailing Address - Country:US
Mailing Address - Phone:707-595-3122
Mailing Address - Fax:707-843-3102
Practice Address - Street 1:4720 HOEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7867
Practice Address - Country:US
Practice Address - Phone:707-595-3122
Practice Address - Fax:707-843-3102
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55246207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G552461Medicaid
CAG55246OtherCA MEDICAL LICENSE
CAG55246OtherCA MEDICAL LICENSE