Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | M1725 | TX |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M1725 | TX |
NPI | 1528020336 |
---|---|
Provider Name | Dr. Jerry Speight Grimes JR. |
First Address | Lubbock, TX 79430-9436 |
Second Address | Lubbock, TX 79430-9436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 09/11/2021 |