Healthcare Provider Details

I. General information

NPI: 1871284497
Provider Name (Legal Business Name): JESSICA MARIE GRIMMOND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2593 HOLIDAY RD
CORALVILLE IA
52241-2781
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-339-1231
  • Fax: 319-688-2930
Mailing address:
  • Phone: 319-384-7222
  • Fax: 319-356-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-56977
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: