Provider Demographics
NPI:1962449041
Name:GRUBER, MELINDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:J
Last Name:GRUBER
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:JASPER
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-996-0410
Mailing Address - Fax:812-996-8497
Practice Address - Street 1:92 W CHRISTMAS BLVD
Practice Address - Street 2:SANTA CLAUS
Practice Address - City:SANTA CLAUS
Practice Address - State:IN
Practice Address - Zip Code:47579-6044
Practice Address - Country:US
Practice Address - Phone:812-937-4120
Practice Address - Fax:812-937-7074
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01045418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00312747OtherRAILROAD MEDICARE
IN200137470Medicaid
INP00312747OtherRAILROAD MEDICARE
IN200137470Medicaid