Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 0101243328 | VA |
NPI | 1104083971 |
---|---|
Provider Name | Michael P Grimes |
First Address | Chesapeake, VA 23320-0302 |
Second Address | Chesapeake, VA 23320-0302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 20/05/2008 |