Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 0101048676 | VA |
NPI | 1023008646 |
---|---|
Provider Name | Dr. Jamie Broome Grimes |
First Address | Bethesda, MD 20889 |
Second Address | Fort Sam Houston, TX 78234-6200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 04/09/2015 |