Provider Demographics
NPI:1982651899
Name:GRUBBS, SHAD T (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAD
Middle Name:T
Last Name:GRUBBS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1606 PRAIRIE CENTER PARKWAY
Mailing Address - Street 2:SUITE #310
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601
Mailing Address - Country:US
Mailing Address - Phone:303-659-5800
Mailing Address - Fax:303-659-5156
Practice Address - Street 1:1606 PRAIRIE CENTER PARKWAY
Practice Address - Street 2:SUITE #310
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601
Practice Address - Country:US
Practice Address - Phone:303-659-5800
Practice Address - Fax:303-659-5156
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO38915207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89055055Medicaid
COP00073483OtherRAILROAD MEDICARE
COH96999Medicare UPIN
C0304283Medicare PIN
COP00073483OtherRAILROAD MEDICARE