Basic Information
| Provider Information | |||||||||
| NPI: | 1538143698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIM | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3649 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992203649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 605 E HOLLAND AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992182225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | PO00000213 | WA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213ES0131X | P 90 | ID | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8869611 | 01 | WA | MEDICARE PTAN GROUP | OTHER | 1071505 | 05 | WA | MEDICAID | 000300588 | 01 | WA | MEDICARE | OTHER | E11326 | 01 | ASURIS | OTHER | GRIMD1132659504 | 01 | PREMERA | OTHER | 480661077 | 01 | RR MC | OTHER |