Provider Demographics
NPI:1215933015
Name:GRUBBS, JAMES HOLT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HOLT
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 1:12308 CARDINAL FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2125
Mailing Address - Country:US
Mailing Address - Phone:817-709-5383
Mailing Address - Fax:
Practice Address - Street 1:12308 CARDINAL FLOWER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-2125
Practice Address - Country:US
Practice Address - Phone:817-709-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF22692084P0804X
VA01012335992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099379203Medicaid
WI34389500Medicaid
TX099379203Medicaid
E77711Medicare UPIN