Individual
MARK A. GRUBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3500 ARENDELL ST, MOREHEAD CITY, NC 28557-2901
(252) 499-6000
(252) 808-6938
Mailing address
404 EASTLEY CT APT 2, KINGSPORT, TN 37660-6411
(803) 479-2372
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
157903
NC
367500000X
Certified Registered Nurse Anesthetist
74148
WV
367500000X
Certified Registered Nurse Anesthetist
RN197129L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165554472
TRICARE
PA
05
—
8053355
—
NC
05
—
8053355
—
ND
Enumeration date
06/06/2006
Last updated
12/21/2019
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