Healthcare Provider Details

I. General information

NPI: 1497787873
Provider Name (Legal Business Name): KELLY DAMON GRIMES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3437 W 7TH ST SUITE 210
FORT WORTH TX
76107-2718
US

IV. Provider business mailing address

3437 W 7TH ST STE 210
FORT WORTH TX
76107-2718
US

V. Phone/Fax

Practice location:
  • Phone: 817-797-6599
  • Fax: 817-735-8049
Mailing address:
  • Phone: 817-797-6599
  • Fax: 817-735-8049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK7749
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberK7749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: