Provider Demographics
NPI:1407841315
Name:GRIMM, WILLIAM JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
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 1:1492 N PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4412
Mailing Address - Country:US
Mailing Address - Phone:760-322-5156
Mailing Address - Fax:760-322-4021
Practice Address - Street 1:1492 N PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4412
Practice Address - Country:US
Practice Address - Phone:760-322-5156
Practice Address - Fax:760-322-4021
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-06-06
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
CA20A6067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00209MMedicare PIN
CAE55685Medicare UPIN