MEDICARE: GRAYCE DOCTEUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA200002329	DC

General Provider Information

NPI Number	:	1356222350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAYCE DOCTEUR

Provider Business Mailing Address
First Line	:	3260 BRANCHE RD
Second Line	:
City	:	CAPE VINCENT
State	:	NY
Zip	:	13618-3178
Country	:	US
Telephone Number	:	315-955-4109
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 BRANCHE RD
Second Line	:
City	:	CAPE VINCENT
State	:	NY
Zip	:	13618-3178
Country	:	US
Telephone Number	:	315-955-4109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	04/10/2026

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Directions to “ GRAYCE DOCTEUR ” Practice Location

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