Provider Demographics
NPI:1467410076
Name:GRAYSON, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:GRAYSON
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 1:5420 MILAN RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5846
Mailing Address - Country:US
Mailing Address - Phone:419-557-5052
Mailing Address - Fax:419-624-0513
Practice Address - Street 1:5420 MILAN RD
Practice Address - Street 2:FIRELANDS CORPORATE HEALTH
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5846
Practice Address - Country:US
Practice Address - Phone:419-557-5052
Practice Address - Fax:419-624-0513
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049350G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0575499Medicaid
OH0575499Medicaid
OHGR7351531Medicare PIN