MEDICARE: DR. JAMES R GRIMES M.D.

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	207Q00000X	Family Medicine Physician	51139	GA
2	207Q00000X	Family Medicine Physician	2006001772	MO

General Provider Information

NPI Number	:	1649262106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R GRIMES M.D.

Provider Business Mailing Address
First Line	:	901 PATIENTS FIRST DR
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-4700
Country	:	US
Telephone Number	:	636-239-4100
Fax Number	:	636-390-4341

Provider Business Practice Location Address
First Line	:	605 E BOONSLICK ROAD
Second Line	:	SUITE B
City	:	WARRENTON
State	:	MO
Zip	:	63383
Country	:	US
Telephone Number	:	636-456-6103
Fax Number	:	636-390-4341

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	01/26/2012

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