Provider Demographics
NPI:1780705152
Name:GRIMES, JOHN JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAMES
Last Name:GRIMES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CENTRE ST
Mailing Address - Street 2:PO BOX 812
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2204
Mailing Address - Country:US
Mailing Address - Phone:781-785-0305
Mailing Address - Fax:
Practice Address - Street 1:30 CENTRE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:MA
Practice Address - Zip Code:02030-2204
Practice Address - Country:US
Practice Address - Phone:781-785-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY 3988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist