Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | C10002212 | DE |
Y | 208600000X | Surgeon | C10002212 | DE |
NPI | 1023016615 |
---|---|
Provider Name | Glenn E Graybeal |
First Address | Milford, DE 19963-1853 |
Second Address | Milford, DE 19963-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 27/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000049201 | (05) | DE |
B66621 | (02) |