Provider Demographics
NPI:1699866558
Name:GRIMM, MARY T (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:T
Last Name:GRIMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:KAYSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:226 S WOODS MILL RD
Mailing Address - Street 2:SUITE 60 WEST
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3662
Mailing Address - Country:US
Mailing Address - Phone:314-878-7333
Mailing Address - Fax:314-878-7453
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:SUITE 60 WEST
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-878-7333
Practice Address - Fax:314-878-7453
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR7P90207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE43760Medicare UPIN