Provider Demographics
NPI:1609332782
Name:TRIMBLE, GRANT WILLIAMS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:WILLIAMS
Last Name:TRIMBLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 WATERSIDE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8587
Mailing Address - Country:US
Mailing Address - Phone:740-418-2007
Mailing Address - Fax:
Practice Address - Street 1:2126 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-2713
Practice Address - Country:US
Practice Address - Phone:530-824-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005897RX207R00000X
CA60457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine