Provider Demographics
NPI:1740286822
Name:GRIMM, TERRENCE R (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:R
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 1:2444 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2162
Mailing Address - Country:US
Mailing Address - Phone:859-277-5766
Mailing Address - Fax:859-277-3406
Practice Address - Street 1:2444 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2162
Practice Address - Country:US
Practice Address - Phone:859-277-5766
Practice Address - Fax:859-277-3406
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25888208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64258882Medicaid
KY0992204Medicare PIN
KY340006343Medicare PIN
KY0169Medicare PIN
KY1275608Medicare PIN
KY64258882Medicaid