Provider Demographics
NPI:1689439879
Name:GRIMMETT, BRIAN LEE
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LEE
Last Name:GRIMMETT
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:OK
Mailing Address - Zip Code:74854-0008
Mailing Address - Country:US
Mailing Address - Phone:405-374-1225
Mailing Address - Fax:800-222-1222
Practice Address - Street 1:32018 HWY 59
Practice Address - Street 2:
Practice Address - City:MAUD
Practice Address - State:OK
Practice Address - Zip Code:74854-0008
Practice Address - Country:US
Practice Address - Phone:580-743-5859
Practice Address - Fax:866-201-3530
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist