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General NPI Number Information
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NPI Number | 1043896806
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Entity Type | Individual
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Provider Name | ARCHER E GRIMLEY MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1820 E SAHARA AVE STE 201
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City | LAS VEGAS
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State | NV
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Zip | 89104-3721
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Country | US
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Telephone | 702-979-1111
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Fax | 702-979-6227
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Provider Business Mailing Address
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Address Line | PO BOX 1000 DEPT 394
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City | MEMPHIS
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State | TN
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Zip | 38148-0001
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Country | US
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Telephone | 941-300-4440
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Fax | 941-404-1760
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26522
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License Number State | NV
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