Provider Demographics
NPI:1982682944
Name:GRUBER, JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
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 1:303 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-1203
Mailing Address - Country:US
Mailing Address - Phone:618-847-8243
Mailing Address - Fax:618-847-8387
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2750
Practice Address - Country:US
Practice Address - Phone:812-547-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045417207Q00000X
KY40685207P00000X
IN01045417A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000594472OtherBLUE SHIELD
IN200173120Medicaid
IN200110370AMedicare ID - Type Unspecified
IN131180VVVMedicare PIN
IN163460NMedicare ID - Type Unspecified
IN200173120Medicaid