Provider Demographics
NPI:1588695761
Name:GRUBER, BRIAN F (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:GRUBER
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 1:17300 N PERIMETER
Mailing Address - Street 2:STE 150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4265
Mailing Address - Country:US
Mailing Address - Phone:602-734-1834
Mailing Address - Fax:602-734-1835
Practice Address - Street 1:17300 N PERIMETER
Practice Address - Street 2:STE 150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4265
Practice Address - Country:US
Practice Address - Phone:602-734-1834
Practice Address - Fax:602-734-1835
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37225174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3Z3910OtherHEALTHNET
AZ267142Medicaid
AZ267142Medicaid
AZZ137016Medicare PIN