Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | M4797 | TX |
NPI | 1023137494 |
---|---|
Provider Name | Kevin Anthony Grimes |
First Address | Houston, TX 77030-2761 |
Second Address | Houston, TX 77030-2761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 15/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
189006301 | (05) | TX |