Provider Demographics
NPI:1558321257
Name:GRIMES, GIL (MD)
Entity type:Individual
Prefix:DR
First Name:GIL
Middle Name:
Last Name:GRIMES
Suffix:
Gender:M
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 617
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-0617
Mailing Address - Country:US
Mailing Address - Phone:325-365-2531
Mailing Address - Fax:325-365-4797
Practice Address - Street 1:2001 HUTCHINS AVE STE C
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-4453
Practice Address - Country:US
Practice Address - Phone:325-365-5737
Practice Address - Fax:325-365-2405
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT1595OtherTEXAS STATE LISENCE
TXP00036778OtherRR/MEDICARE
TX1589780-02OtherCSHCN
TX1589780-01Medicaid
TX8J8272OtherBLUE SHIELD
TX1589780-02OtherCSHCN