Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2019029136 | MO |
N | 207N00000X | Dermatologist | 35.133142 | OH |
N | 207ND0101X | MOHS-Micrographic Surgeon | 2019029136 | MO |
NPI | 1134547656 |
---|---|
Provider Name | Dr. Paul Gruber |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Saint Peters, MO 63376-1667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 16/09/2021 |