Provider Demographics
NPI:1235119405
Name:GRIMSHAW, ARMAND C (MD)
Entity Type:Individual
Prefix:
First Name:ARMAND
Middle Name:C
Last Name:GRIMSHAW
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 1:1890 W GAUTHIER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-7179
Mailing Address - Country:US
Mailing Address - Phone:337-474-5519
Mailing Address - Fax:337-474-6313
Practice Address - Street 1:1890 W GAUTHIER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7179
Practice Address - Country:US
Practice Address - Phone:337-474-5519
Practice Address - Fax:337-474-6313
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020473207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1924555Medicaid
LA5R528C423Medicare ID - Type Unspecified
LA1924555Medicaid