Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 327 | AL |
N | 213ES0103X | Foot & Ankle Surgery | 327 | AL |
NPI | 1487098166 |
---|---|
Provider Name | Dr. Dustin John Grimmett |
First Address | Guntersville, AL 35976-7137 |
Second Address | Guntersville, AL 35976-7137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 22/08/2017 |