Individual
JOHN O. GRIMM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
225 CROSSLAKE DR, EVANSVILLE, IN 47715-8198
(812) 477-1558
Mailing address
225 CROSSLAKE DR, EVANSVILLE, IN 47715-8198
(812) 477-1558
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
1037941
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000108308
ANTHEM
IN
01
—
130960
HEALTHLINK
IN
Enumeration date
07/07/2005
Last updated
07/08/2007
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