Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0101020808 | VA |
NPI | 1871698704 |
---|---|
Provider Name | Dr. Richard Joseph Grayson JR. |
First Address | Roanoke, VA 24014-3421 |
Second Address | Roanoke, VA 24014-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |