Basic Information
| Provider Information | |||||||||
| NPI: | 1003009705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODS-GRIMM | ||||||||
| FirstName: | SERENA | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7113 W SUPERIOR AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850437293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232101150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 N CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850048001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022216326 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 37116 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 325855 | 05 | AZ | MEDICAID |