Healthcare Provider Details

I. General information

NPI: 1689644833
Provider Name (Legal Business Name): JAMES M GRIMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 106A
SAINT AUGUSTINE FL
32080-3109
US

IV. Provider business mailing address

PO BOX 3266
ST AUGUSTINE FL
32085-3266
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-8365
  • Fax: 904-217-3224
Mailing address:
  • Phone: 904-819-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME68197
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME68197
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: