Individual
RANDY VINCENT GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
(918) 256-3628
Mailing address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
(918) 256-3628
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/03/2023
Last updated
07/09/2023
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