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NPI Code Detail

MEDICARE: MR. CLARENCE E. GRIM M.D.

MEDICARE: MR. CLARENCE E. GRIM 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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician36279WI
2207R00000XInternal Medicine Physician36279WI
3207RG0300XGeriatric Medicine (Internal Medicine) Physician14040NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760404768
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLARENCE E. GRIM M.D.
Provider Business Mailing Address
First Line : 195 HWY 50, SUITE #104
Second Line : PMB 7172-289
City : STATELINE
State : NV
Zip : 89449-7172
Country : US
Telephone Number : 414-916-0841
Fax Number :
Provider Business Practice Location Address
First Line : 1180 N TOWN CENTER DR STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-6308
Country : US
Telephone Number : 414-916-0841
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 03/10/2020

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