Provider Demographics
NPI:1356333785
Name:GRAYSON, DEBRA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3160
Mailing Address - Country:US
Mailing Address - Phone:614-575-6270
Mailing Address - Fax:614-575-6282
Practice Address - Street 1:4677 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3160
Practice Address - Country:US
Practice Address - Phone:614-575-6270
Practice Address - Fax:614-575-6282
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716354Medicaid
OH0716354Medicaid
OH9283251Medicare UPIN
OH0589351Medicare PIN