Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD0000020743 | TN |
NPI | 1023067972 |
---|---|
Provider Name | Arthur Grimball |
First Address | Jackson, TN 38301-3912 |
Second Address | Jackson, TN 38301-3912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 10/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3054967 | (05) | TN |
B92142 | (02) | TN |