Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 35073014 | OH |
NPI | 1154303501 |
---|---|
Provider Name | Todd E Grime |
First Address | Hamilton, OH 45013-9049 |
Second Address | Cincinnati, OH 45249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 25/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154303501 | NPI (01) | NY |
2162378 | (05) | OH |
H05882 | (02) | NY |