Provider Demographics
NPI:1174589808
Name:GRUBBS, PETER ALAN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ALAN
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:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5504
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:3223 EDEN & ALBERT SABIN
Practice Address - Street 2:# 405
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0405
Practice Address - Country:US
Practice Address - Phone:513-584-6868
Practice Address - Fax:513-584-6040
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053791207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110233061OtherRAIL ROAD MEDICARE
OH0877903Medicaid
KY64938764Medicaid
IN200152460Medicaid
OH0877903Medicaid
F26147Medicare UPIN