Provider Demographics
NPI:1386681633
Name:NORQUIST, GRAYSON S (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:S
Last Name:NORQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5888
Mailing Address - Fax:601-984-5842
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5888
Practice Address - Fax:601-984-5842
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS084012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09181535Medicaid
MS512I260003Medicare PIN
MS260000689Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MS09181535Medicaid
MS302I265623Medicare PIN