Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD448565 | PA |
N | 208600000X | Surgeon | MD448565 | PA |
N | 2086S0129X | Vascular Surgeon | 33217 | AZ |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 54798 | TN |
NPI | 1083615934 |
---|---|
Provider Name | Grayson H Wheatley III |
First Address | Nashville, TN 37203-1562 |
Second Address | Nashville, TN 37203-1562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 03/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54798 | TN MEDICAL LICENSE (01) | TN |
891186 | (05) | AZ |
I18735 | (02) | AZ |
P00219385 | RAILROAD MEDICARE (01) | AZ |
WCSKQ | SUN HEALTH GROUP # (01) | AZ |