Individual
MR. CLINTON LLOYD GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS
Contact information
Practice address
369026 US HIGHWAY 62, BOLEY, OK 74829
(918) 667-3367
Mailing address
NBU 6907, PRAGUE, OK 74864
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100685660A
—
OK
05
—
100685660D
—
OK
Enumeration date
02/19/2008
Last updated
08/26/2019
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