MEDICARE: DR. ERIK GRIMM DO

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
1	208000000X	Pediatrics Physician	DO196972	OR
2	208000000X	Pediatrics Physician	DO3964	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	DO3964	OTHER	NV	LICENSE

General Provider Information

NPI Number	:	1235660176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIK GRIMM DO

Provider Business Mailing Address
First Line	:	6355 S BUFFALO DR FL 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2133
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 N TENAYA WAY STE 308
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1102
Country	:	US
Telephone Number	:	702-870-2099
Fax Number	:	702-896-5347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	12/08/2025

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Directions to “ DR. ERIK GRIMM DO” Practice Location

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