Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0000X | Obstetrician | 04-16408 | KS |
Y | 207VX0000X | Obstetrician | 0416408 | KS |
NPI | 1396841367 |
---|---|
Provider Name | Gary A. Grimaldi |
First Address | Pittsburg, KS 66762 |
Second Address | Pittsburg, KS 66762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 13/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100128140A | (05) | KS |
D05231 | (02) |