Provider Demographics
NPI:1356548531
Name:GRIMM, ALAN RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
Last Name:GRIMM
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 1:6000 W HIGHWAY 98
Mailing Address - Street 2:NAVAL HOSPITAL PENSACOLA
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0003
Mailing Address - Country:US
Mailing Address - Phone:850-505-6456
Mailing Address - Fax:
Practice Address - Street 1:6000 W HIGHWAY 98
Practice Address - Street 2:NAVAL HOSPITAL PENSACOLA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0003
Practice Address - Country:US
Practice Address - Phone:850-505-6456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21968207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology