Provider Demographics
NPI:1235660176
Name:GRIMM, ERIK (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:GRIMM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16463 BOONES FERRY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4377
Mailing Address - Country:US
Mailing Address - Phone:503-635-3743
Mailing Address - Fax:
Practice Address - Street 1:16463 BOONES FERRY RD STE 400
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4377
Practice Address - Country:US
Practice Address - Phone:503-635-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO196972208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics