Provider Demographics
NPI:1003009705
Name:WOODS-GRIMM, SERENA DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:DAWN
Last Name:WOODS-GRIMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 W SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7293
Mailing Address - Country:US
Mailing Address - Phone:623-210-1150
Mailing Address - Fax:
Practice Address - Street 1:201 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-8001
Practice Address - Country:US
Practice Address - Phone:602-221-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ325855Medicaid
AZZ125333Medicare PIN