Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101240898 | VA |
N | 208600000X | Surgeon | 0101240898 | VA |
Y | 2086S0102X | Surgical Critical Care | 0101240898 | VA |
N | 2086S0127X | Trauma Surgeon | 0101240898 | VA |
NPI | 1033312863 |
---|---|
Provider Name | Dr. John Christopher Graybill |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | Fort Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 14/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101230898 | MEDICAL LICENSE (01) | VA |