Basic Information
| Provider Information | |||||||||
| NPI: | 1811066749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRUMLEY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7448 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420027448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704414200 | ||||||||
| FaxNumber: | 2704414249 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 MEDICAL CENTER DRIVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704414200 | ||||||||
| FaxNumber: | 2704414249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | 20114 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64201148 | 05 | KY | MEDICAID |