Provider Demographics
NPI:1881891067
Name:GRUBB, GARY W (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:GRUBB
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1672 W AVENUE J
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2827
Mailing Address - Country:US
Mailing Address - Phone:661-945-0821
Mailing Address - Fax:661-948-6255
Practice Address - Street 1:1672 W AVENUE J
Practice Address - Street 2:SUITE 105
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2827
Practice Address - Country:US
Practice Address - Phone:661-945-0821
Practice Address - Fax:661-948-6255
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-08-09
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Provider Licenses
StateLicense IDTaxonomies
CAG43124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine