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Individual

MR. CLARENCE E. GRIM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1180 N TOWN CENTER DR STE 100, LAS VEGAS, NV 89144-6308
(414) 916-0841
Mailing address
195 HWY 50, SUITE #104, PMB 7172-289, STATELINE, NV 89449-7172
(414) 916-0841

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
36279
WI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
36279
WI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
14040
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32093400
WI
Enumeration date
07/25/2006
Last updated
03/10/2020
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