Provider Demographics
NPI:1346503448
Name:GRAU, CONSTANCE BLAINE (DO)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:BLAINE
Last Name:GRAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CONSTANCE
Other - Middle Name:BLAINE
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1522 E A ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2217
Mailing Address - Country:US
Mailing Address - Phone:417-354-1500
Mailing Address - Fax:
Practice Address - Street 1:1522 E A ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2217
Practice Address - Country:US
Practice Address - Phone:307-234-6161
Practice Address - Fax:307-234-7032
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9914A207Q00000X
MO2015029483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine