Provider Demographics
NPI:1013942739
Name:GRAUL, CRAIG S (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:GRAUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MANCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-6632
Mailing Address - Country:US
Mailing Address - Phone:423-573-1988
Mailing Address - Fax:
Practice Address - Street 1:104 MANCHESTER PL
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-6632
Practice Address - Country:US
Practice Address - Phone:423-573-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201380207R00000X, 207P00000X
TNDO1918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004735D11OtherTRAILBLAZER PART B MEDICA
VA144500OtherANTHEM BLUE CROSS
TN1506538Medicaid
KY7100142630Medicaid
VA7267547OtherAETNA
VATN 0104OtherJOHN DEERE
VA1013942739Medicaid
VA1213334OtherCHA
VA010079641Medicaid
VA017051H81Medicare UPIN
TN3700592Medicare UPIN
KY7100142630Medicaid
TN1506538Medicaid
TN3001366Medicare UPIN
VA144500OtherANTHEM BLUE CROSS
VA491303Medicare ID - Type Unspecified
VAVAA104667Medicare PIN