Provider Demographics
NPI:1114487246
Name:GRUBBS, HAILEY (DO)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1101
Mailing Address - Country:US
Mailing Address - Phone:904-403-5092
Mailing Address - Fax:
Practice Address - Street 1:2221 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1101
Practice Address - Country:US
Practice Address - Phone:610-623-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20055207N00000X
PAOS023624207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology