Provider Demographics
NPI:1245779156
Name:GRIMM, RAYMOND GREY
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:GREY
Last Name:GRIMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 LANTANA AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-1427
Mailing Address - Country:US
Mailing Address - Phone:727-580-2702
Mailing Address - Fax:
Practice Address - Street 1:741 LANTANA AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER BEACH
Practice Address - State:FL
Practice Address - Zip Code:33767-1427
Practice Address - Country:US
Practice Address - Phone:727-580-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist