Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 35.076861 | OH |
N | 2086S0127X | Trauma Surgeon | 35076861 | OH |
NPI | 1518072784 |
---|---|
Provider Name | Brian Scott Gruber |
First Address | Youngstown, OH 44510-1617 |
Second Address | Youngstown, OH 44510-1617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 12/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2573317 | (05) | OH |
H149640 | MEDICARE PTAN (01) | OH |
I30748 | (02) | OH |