Provider Demographics
NPI:1194720755
Name:GRIMM, GAYETTE F (MD)
Entity type:Individual
Prefix:
First Name:GAYETTE
Middle Name:F
Last Name:GRIMM
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-0430
Mailing Address - Country:US
Mailing Address - Phone:515-832-9400
Mailing Address - Fax:515-832-9494
Practice Address - Street 1:2350 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-6600
Practice Address - Country:US
Practice Address - Phone:515-832-9400
Practice Address - Fax:515-832-9494
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35557208600000X
WI46673208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34568200Medicaid
WI0146Medicare PIN
WI34568200Medicaid