Individual
MR. MICHAEL DANA GRIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2828 1ST AVE, SUITE 400, HUNTINGTON, WV 25702-1236
(304) 525-6905
(304) 525-4316
Mailing address
2828 1ST AVE, SUITE 400, HUNTINGTON, WV 25702-1236
(304) 525-6905
(304) 525-4316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
905
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
381000527
—
WV
01
—
905
STATE LICENSE
WV
Enumeration date
11/09/2006
Last updated
03/07/2023
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