Provider Demographics
NPI:1396781142
Name:GRIMES, ALLEN E JR (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:E
Last Name:GRIMES
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:650 NEWTOWN PIKE
Mailing Address - Street 2:LEXINGTON FAYETTE CO HEALTH DEPT PRIMARY CARE CENTER
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1197
Mailing Address - Country:US
Mailing Address - Phone:859-288-2351
Mailing Address - Fax:859-288-7510
Practice Address - Street 1:650 NEWTOWN PIKE
Practice Address - Street 2:LEXINGTON FAYETTE CO HEALTH DEPT PRIMARY CARE CENTER
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1197
Practice Address - Country:US
Practice Address - Phone:859-288-2351
Practice Address - Fax:859-288-7510
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
KY13463208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64134638Medicaid
AG3002932OtherDEA
KY64134638Medicaid
AG3002932OtherDEA