Basic Information
| Provider Information | |||||||||
| NPI: | 1548494040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRUBBS | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DANIEL | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | ADRIANE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 328 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750573866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724367557 | ||||||||
| FaxNumber: | 9722218246 | ||||||||
| Practice Location | |||||||||
| Address1: | 328 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750573866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724367557 | ||||||||
| FaxNumber: | 9722218246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 09/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | BP10033773 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 538393 | 01 | TX | PHYSICIAN IN TRAINING PERMIT ID NUMBER | OTHER |