Provider Demographics
NPI:1710984380
Name:SELF, WILLIAM GRADY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GRADY
Last Name:SELF
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:8403 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3809
Mailing Address - Country:US
Mailing Address - Phone:303-426-4810
Mailing Address - Fax:303-426-8708
Practice Address - Street 1:8403 BRYANT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3809
Practice Address - Country:US
Practice Address - Phone:303-426-4810
Practice Address - Fax:303-426-8708
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO20828207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
222002OtherUNITED HEALTHCARE
180032795OtherRAILROAD MEDICARE
CO01208289Medicaid
4098038OtherAETNA PPO
840787518002OtherROCKY MTN HEALTH PLAN
840787518A002OtherTRICARE
920665OtherEYE SPECIALISTS
0800375OtherEVERCARE
SE87324OtherBLUE CROSS/BLUE SHIELD
814630OtherAETNA HMO
4098038OtherAETNA PPO
COC87324Medicare PIN