Provider Demographics
NPI:1841443876
Name:GRIMES, JUDITH L
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:GRIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 STANLEY RD
Mailing Address - Street 2:SUITE 91
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-7648
Mailing Address - Country:US
Mailing Address - Phone:210-295-7618
Mailing Address - Fax:210-295-7523
Practice Address - Street 1:1706 STANLEY RD
Practice Address - Street 2:SUITE 91
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7648
Practice Address - Country:US
Practice Address - Phone:210-295-7618
Practice Address - Fax:210-295-7523
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman