Provider Demographics
NPI:1063667889
Name:GRIMM, BRADFORD PEARCE (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:PEARCE
Last Name:GRIMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2705
Mailing Address - Country:US
Mailing Address - Phone:704-633-7220
Mailing Address - Fax:704-647-0515
Practice Address - Street 1:612 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2732
Practice Address - Country:US
Practice Address - Phone:704-633-7220
Practice Address - Fax:704-647-0515
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01752207Q00000X, 208M00000X
OH57.015338208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery