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Individual

DR. JUDITH BYNUM GRIMM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
4600 ROGERS AVE, FORT SMITH, AR 72903-3149
(479) 494-7443
Mailing address
464847 E 1098 RD, SALLISAW, OK 74955-5320
(318) 794-9937

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-9002
AR
207Q00000X
Family Medicine Physician
MD.14759R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
030477389
HUMANA
LA
05
1438154
LA
Enumeration date
05/12/2006
Last updated
04/26/2018
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