MEDICARE: DR. DOUGLAS J GRIMM DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	1514	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8A2740	OTHER	TX	BLUECROSS/BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548293491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS J GRIMM DPM

Provider Business Mailing Address
First Line	:	7700 CAT HOLLOW DRIVE
Second Line	:	SUITE 102
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4068
Country	:	US
Telephone Number	:	512-733-8600
Fax Number	:	512-733-8602

Provider Business Practice Location Address
First Line	:	7700 CAT HOLLOW DRIVE
Second Line	:	SUITE 102
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4068
Country	:	US
Telephone Number	:	512-733-8600
Fax Number	:	512-733-8602

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/27/2008

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