Individual
MR. JUSTIN ROGER GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1305 WONDER WORLD DR, STE 105, SAN MARCOS, TX 78666-7546
(512) 353-8161
(512) 353-8255
Mailing address
2804 W BIDDISON ST, FORT WORTH, TX 76109-3039
(806) 928-5053
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
744531
TX
Other
Enumeration date
01/22/2014
Last updated
10/28/2014
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