Provider Demographics
NPI:1720029275
Name:GRAYSON, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
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:PO BOX 636019
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6019
Mailing Address - Country:US
Mailing Address - Phone:865-985-7234
Mailing Address - Fax:865-985-7077
Practice Address - Street 1:1850 OLD KNOXVILLE RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3625
Practice Address - Country:US
Practice Address - Phone:423-626-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36478207P00000X
LAMD.13301R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1561100Medicaid
TN4067317OtherBCBS OF TENNESSEE
TNP00255392OtherRAILROAD MEDICARE
TN3875615Medicaid
VA010256682Medicaid
TNH08129Medicare UPIN
TN4067317OtherBCBS OF TENNESSEE
TN3875615Medicaid