Individual
MARK W GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1011 BOWLES AVE, SUITE 405, FENTON, MO 63026-2395
(314) 965-9184
Mailing address
PO BOX 790379, SAINT LOUIS, MO 63179-0379
(314) 965-9184
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2001018662
MO
Other
Enumeration date
01/31/2006
Last updated
05/19/2011
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