Provider Demographics
NPI:1174817704
Name:GRIMES, TROY TOLIVER (ATP)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:TOLIVER
Last Name:GRIMES
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2705
Mailing Address - Country:US
Mailing Address - Phone:877-832-6060
Mailing Address - Fax:409-832-6061
Practice Address - Street 1:9407 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2705
Practice Address - Country:US
Practice Address - Phone:877-832-6060
Practice Address - Fax:409-832-6060
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other