Individual
ELLEN M. GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1330 WONDER WORLD DR, SAN MARCOS, TX 78666-7566
(512) 805-0680
(512) 805-0682
Mailing address
12221 N MOPAC EXPY, AUSTIN, TX 78758-2401
(512) 805-0680
(512) 805-0682
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
J4170
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101802002
—
TX
05
—
101802004
—
TX
01
—
390007009
RAILROAD MEDICARE
TX
Enumeration date
02/28/2006
Last updated
02/01/2022
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