Individual
DR. TIMOTHY GUY GRUBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
219 S BALLIET ST, FRACKVILLE, PA 17931-2105
(570) 874-3404
(570) 874-1491
Mailing address
219 S BALLIET ST, FRACKVILLE, PA 17931-2105
(570) 874-3404
(570) 874-1491
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
OS009280L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018174270002
—
PA
Enumeration date
06/17/2005
Last updated
09/10/2014
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