Provider Demographics
NPI:1689724130
Name:GRAYBIEL, ASHTON LYND (MD)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:LYND
Last Name:GRAYBIEL
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 1:2441 N 9TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3911
Mailing Address - Country:US
Mailing Address - Phone:850-434-9992
Mailing Address - Fax:850-435-2525
Practice Address - Street 1:2441 N 9TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-3911
Practice Address - Country:US
Practice Address - Phone:850-434-9992
Practice Address - Fax:850-435-2525
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019255207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0019255OtherMEDICAL LICENSURE NUMBER
FL054149400Medicaid
AL59002286OtherBC BS ALABAMA
FL3206912OtherUNITED HEALTH CARE
FLD82374Medicare UPIN
FL054149400Medicaid