Provider Demographics
NPI:1942299276
Name:GRIM, GLORIA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ANN
Last Name:GRIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:16869 N WINSLOW DR
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-2298
Mailing Address - Country:US
Mailing Address - Phone:918-456-0671
Mailing Address - Fax:918-458-6174
Practice Address - Street 1:900 N OWEN WALTERS BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:OK
Practice Address - Zip Code:74365-5003
Practice Address - Country:US
Practice Address - Phone:918-434-8500
Practice Address - Fax:918-458-6174
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK18956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF88931Medicare UPIN