Provider Demographics
NPI:1881797033
Name:GRIMES, ERIN JOHNSON (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JOHNSON
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 E 101ST ST
Mailing Address - Street 2:PMB 431 SUITE D1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6724
Mailing Address - Country:US
Mailing Address - Phone:918-895-7808
Mailing Address - Fax:918-895-7807
Practice Address - Street 1:7723 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6053
Practice Address - Country:US
Practice Address - Phone:918-895-7808
Practice Address - Fax:918-895-7807
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24908207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine