Provider Demographics
NPI:1437108586
Name:GRAYSON, DAVID DILLARD JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DILLARD
Last Name:GRAYSON
Suffix:JR
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 1:807 CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-2826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7900 FM 1826
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-1407
Practice Address - Country:US
Practice Address - Phone:254-771-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9496207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137415907Medicaid
TX137415905Medicaid
TX930096804Medicare PIN
TX8857K1Medicare PIN
TXC97749Medicare UPIN
TX8045K2Medicare PIN
TX137415907Medicaid