Provider Demographics
NPI:1598705030
Name:GRAYSON, GUY HOWARD (MD PA)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:HOWARD
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531030
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1030
Mailing Address - Country:US
Mailing Address - Phone:866-242-0010
Mailing Address - Fax:956-365-4423
Practice Address - Street 1:1911 LUBBOCK ST
Practice Address - Street 2:SUITE C
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8233
Practice Address - Country:US
Practice Address - Phone:866-242-0010
Practice Address - Fax:956-365-4423
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ05072080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134968009Medicaid
TX8A7723Medicare ID - Type Unspecified
TX134968009Medicaid