Provider Demographics
NPI:1043896806
Name:GRIMLEY, ARCHER E (MD)
Entity type:Individual
Prefix:
First Name:ARCHER
Middle Name:E
Last Name:GRIMLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JESSICA
Other - Last Name:GRIMLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1000 DEPT 394
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:941-300-4440
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:1820 E SAHARA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3721
Practice Address - Country:US
Practice Address - Phone:702-979-1111
Practice Address - Fax:702-979-6227
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV26522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine