Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 1944023 | WI |
N | 207PE0004X | Emergency Medical Services | 1944023 | WI |
N | 207PP0204X | Pediatric Emergency Physician | 1944023 | WI |
NPI | 1740234772 |
---|---|
Provider Name | John Joseph Graykoski |
First Address | Eau Claire, WI 54702-1510 |
Second Address | Barron, WI 54812-1765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 11/10/2019 |