Provider Demographics
NPI:1710098348
Name:GRAYSON, WALTER PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:PAUL
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 1:2700 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:816-346-7690
Practice Address - Street 1:5400 N. OAK TRAFFICWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118
Practice Address - Country:US
Practice Address - Phone:816-453-6200
Practice Address - Fax:816-455-0595
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4C81207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09483018OtherBCBS
MO201766409Medicaid
MO201766409Medicaid
MOMA5696001Medicare PIN
MO09483018OtherBCBS