Basic Information
| Provider Information | |||||||||
| NPI: | 1669852984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRUBE | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 N CLYDE MORRIS BLVD | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862264590 | ||||||||
| FaxNumber: | 3862263371 | ||||||||
| Practice Location | |||||||||
| Address1: | 1165 DUNLAWTON AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864254787 | ||||||||
| FaxNumber: | 3864254788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2015 | ||||||||
| LastUpdateDate: | 08/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | ME129958 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | ME129958 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.