Provider Demographics
NPI:1922041912
Name:GRIMES, WILLIAM REID (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:REID
Last Name:GRIMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 E BERT KOUNS STE 430
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5741
Mailing Address - Country:US
Mailing Address - Phone:318-424-8373
Mailing Address - Fax:318-424-6477
Practice Address - Street 1:1811 E BERT KOUNS STE 430
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-424-8373
Practice Address - Fax:318-424-6477
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015952208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106411502Medicaid
LA1397202Medicaid
5L978Medicare ID - Type Unspecified