Provider Demographics
NPI:1831121961
Name:GRAYSON, RICK DEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:DEAN
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1507
Mailing Address - Country:US
Mailing Address - Phone:660-584-2927
Mailing Address - Fax:660-584-7444
Practice Address - Street 1:12 W 19TH ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1507
Practice Address - Country:US
Practice Address - Phone:660-584-2927
Practice Address - Fax:660-584-7444
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000672213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U44048Medicare UPIN
KSY185328Medicare PIN