Provider Demographics
NPI:1174581839
Name:GRUBB, KRISTEN RAE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:RAE
Last Name:GRUBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:RAE
Other - Last Name:HAUGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22100 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8431
Mailing Address - Country:US
Mailing Address - Phone:855-687-7237
Mailing Address - Fax:855-687-7237
Practice Address - Street 1:24493 CORNERSTONE
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4125
Practice Address - Country:US
Practice Address - Phone:855-687-7237
Practice Address - Fax:855-673-9190
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0441222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology