Provider Demographics
NPI:1245492586
Name:GRIMM, MARY ELEANOR (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELEANOR
Last Name:GRIMM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5035 E SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1712
Mailing Address - Country:US
Mailing Address - Phone:520-299-6711
Mailing Address - Fax:520-299-6711
Practice Address - Street 1:5035 E SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1712
Practice Address - Country:US
Practice Address - Phone:520-299-6711
Practice Address - Fax:520-299-6711
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ10277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE 00825Medicare UPIN
AZ0000BCNPMMedicare PIN