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NPI Code Detail

MEDICARE: ARCHER E GRIMLEY MD

MEDICARE: ARCHER E GRIMLEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician26522NV

General Provider Information

NPI Number : 1043896806
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARCHER E GRIMLEY MD
Provider Business Mailing Address
First Line : PO BOX 1000 DEPT 394
Second Line :
City : MEMPHIS
State : TN
Zip : 38148-0001
Country : US
Telephone Number : 941-300-4440
Fax Number : 941-404-1760
Provider Business Practice Location Address
First Line : 1820 E SAHARA AVE STE 201
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3721
Country : US
Telephone Number : 702-979-1111
Fax Number : 702-979-6227
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2021
Last Update Date : 03/20/2026

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Directions to “ ARCHER E GRIMLEY MD” Practice Location

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