Basic Information
| Provider Information | |||||||||
| NPI: | 1932164316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRUBBS | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 PENNSYLVANIA AVE | ||||||||
| Address2: | OFFICE OF NEONATOLOGY | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178822892 | ||||||||
| FaxNumber: | 8178785335 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PENNSYLVANIA AVE | ||||||||
| Address2: | OFFICE OF NEONATOLOGY | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178822892 | ||||||||
| FaxNumber: | 8178785335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | L9220 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.