Doctor Name: | DR. AMBER K GRUTERS |
NPI Number: | 1306073598 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 28232 |
Business Practice Address: | 650 Joel Dr Fort Campbell, KY - 422235318 |
Business Phone Number: | 2707988372 |
Business Fax Number: | |
Mailing Address: | 650 Joel Dr, FORT CAMPBELL |
State: | KY |
Postal Code: | 422235318 |
Phone Number: | 2707988372 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2009 |
NPI Last Update Date: | 01/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 28232 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |