Provider Demographics
NPI:1285619403
Name:GRUMLEY, SCOTT ALAN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:GRUMLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-1328
Mailing Address - Country:US
Mailing Address - Phone:205-221-3523
Mailing Address - Fax:205-221-3560
Practice Address - Street 1:1450 JONES DAIRY RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-6106
Practice Address - Country:US
Practice Address - Phone:205-295-4110
Practice Address - Fax:205-952-4101
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL000211482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH14694Medicare UPIN