Provider Demographics
NPI:1093989576
Name:RICHARD R GRAYSON MD PC
Entity Type:Organization
Organization Name:RICHARD R GRAYSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-377-7073
Mailing Address - Street 1:330 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1204
Mailing Address - Country:US
Mailing Address - Phone:630-377-7073
Mailing Address - Fax:630-406-1380
Practice Address - Street 1:330 MAPLE LN
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1204
Practice Address - Country:US
Practice Address - Phone:630-377-7073
Practice Address - Fax:630-406-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1205859295OtherNPI
IL301220Medicare PIN