Provider Demographics
NPI:1205896347
Name:GRUBBS, DANNY EUGENE (MD)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:EUGENE
Last Name:GRUBBS
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 1:3202 METHODIST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7408
Mailing Address - Country:US
Mailing Address - Phone:870-932-2221
Mailing Address - Fax:870-931-3229
Practice Address - Street 1:3202 METHODIST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7408
Practice Address - Country:US
Practice Address - Phone:870-932-2221
Practice Address - Fax:870-931-3229
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5642207P00000X
ARC5642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101837001Medicaid
AR115131002Medicaid
AR52043Medicare PIN
AR520437832Medicare PIN
ARB90248Medicare UPIN