Healthcare Provider Details

I. General information

NPI: 1639346919
Provider Name (Legal Business Name): WALTER RANDALL GRAIL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RANDY GRAIL RRT

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NORTH AVE
GRAND JUNCTION CO
81501-6428
US

IV. Provider business mailing address

3001 MILBURN DR
GRAND JUNCTION CO
81504-5760
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-5062
  • Fax:
Mailing address:
  • Phone: 970-640-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number581
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: