Individual
JAISON A GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
355 W 16TH ST, SUITE 3200, INDIANAPOLIS, IN 46202-2207
(317) 963-7400
(317) 963-7425
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01071593A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000803404
ANTHEM PTAN
IN
05
—
201109710
—
IN
Enumeration date
07/03/2008
Last updated
03/08/2025
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