Provider Demographics
NPI:1538359450
Name:GRIMES, WILLIAM W (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:GRIMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S FM 51
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3702
Mailing Address - Country:US
Mailing Address - Phone:940-626-1870
Mailing Address - Fax:940-626-1871
Practice Address - Street 1:2000 S FM 51
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3702
Practice Address - Country:US
Practice Address - Phone:940-626-1870
Practice Address - Fax:940-626-1871
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF59262084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V4960OtherBCBS
TXP00296205OtherMEDICARE RR
TXPENDINGMedicaid
TX8F24358Medicare PIN