Provider Demographics
NPI:1598741472
Name:GRIMES, ROBERT W JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:GRIMES
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:8919 PARALLEL PKWY STE 555
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-3628
Mailing Address - Country:US
Mailing Address - Phone:913-596-3940
Mailing Address - Fax:913-596-3730
Practice Address - Street 1:8919 PARALLEL PKWY STE 555
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-3628
Practice Address - Country:US
Practice Address - Phone:913-596-3940
Practice Address - Fax:913-596-3730
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1500671363A00000X
KS15-00671363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS15-00671OtherSTATE PA LICENSE NUMBER
KS15-00671OtherSTATE PA LICENSE NUMBER