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General NPI Number Information
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NPI Number | 1619960127
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Entity Type | Individual
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Provider Name | MISTI GRIMSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 4001 WORTH ST
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City | DALLAS
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State | TX
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Zip | 75246-1608
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Country | US
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Telephone | 214-828-1745
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Fax | 214-828-1734
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Provider Business Mailing Address
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Address Line | 4001 WORTH ST
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City | DALLAS
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State | TX
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Zip | 75246-1608
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Country | US
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Telephone | 214-828-1745
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Fax | 214-828-1734
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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 | 35082326G
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License Number State | OH
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