Provider Demographics
NPI:1477588200
Name:GRIMES, TATE ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:TATE
Middle Name:ALEXANDER
Last Name:GRIMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8140 WALNUT HILL LN
Mailing Address - Street 2:SUITE 308
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4350
Mailing Address - Country:US
Mailing Address - Phone:214-348-5557
Mailing Address - Fax:214-348-5898
Practice Address - Street 1:8140 WALNUT HILL LN
Practice Address - Street 2:SUITE 308
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4350
Practice Address - Country:US
Practice Address - Phone:214-348-5557
Practice Address - Fax:214-348-5898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9553207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H23697Medicare UPIN