Provider Demographics
NPI:1285739292
Name:DANNY E GRUBBS
Entity type:Organization
Organization Name:DANNY E GRUBBS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-932-2221
Mailing Address - Street 1:3202 METHODIST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7408
Mailing Address - Country:US
Mailing Address - Phone:870-932-2221
Mailing Address - Fax:870-931-3229
Practice Address - Street 1:3202 METHODIST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7408
Practice Address - Country:US
Practice Address - Phone:870-932-2221
Practice Address - Fax:870-931-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115131002Medicaid
AR57832Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER