Provider Demographics
NPI:1073132510
Name:GRIMES, ERIN L (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BROADWAY BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3342
Mailing Address - Country:US
Mailing Address - Phone:816-931-9344
Mailing Address - Fax:816-931-4168
Practice Address - Street 1:4400 BROADWAY BLVD STE 302
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3342
Practice Address - Country:US
Practice Address - Phone:816-931-9344
Practice Address - Fax:816-931-4168
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2024023895207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program