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Individual
SHANNON L GRUBB
Active
Individual
SHANNON L GRUBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35057544G
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0728672
—
OH
01
—
GR4124482
MEDICARE PTAN
OH
Enumeration date
08/16/2005
Last updated
06/23/2014
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