Provider Demographics
NPI:1982991816
Name:GRUBBS, EDWARD EUGENE JR (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:EUGENE
Last Name:GRUBBS
Suffix:JR
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 ARCOS AVE
Mailing Address - Street 2:205
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9459
Mailing Address - Country:US
Mailing Address - Phone:239-495-2400
Mailing Address - Fax:239-495-5916
Practice Address - Street 1:10201 ARCOS AVE
Practice Address - Street 2:205
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9459
Practice Address - Country:US
Practice Address - Phone:239-495-2400
Practice Address - Fax:239-495-5916
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3677237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist