Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 66948 | WI |
Y | 207PP0204X | Pediatric Emergency Physician | 2021013348 | MO |
N | 2080P0204X | Pediatric Emergency Doctor | 66948 | WI |
NPI | 1528358603 |
---|---|
Provider Name | Anna Grimes |
First Address | Springfield, MO 65804-2203 |
Second Address | Springfield, MO 65804-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 19/04/2021 |