Provider Demographics
NPI:1952312811
Name:GRIMES, JILL ANN (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:LITZINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5656 BEE CAVE RD STE E200
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5035
Mailing Address - Country:US
Mailing Address - Phone:512-328-8880
Mailing Address - Fax:512-328-8933
Practice Address - Street 1:5656 BEE CAVE RD STE E200
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5035
Practice Address - Country:US
Practice Address - Phone:512-328-8880
Practice Address - Fax:512-328-8933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ2163OtherLICENSE NUMBER
TXF87409Medicare UPIN