Healthcare Provider Details

I. General information

NPI: 1255447728
Provider Name (Legal Business Name): JAMES WILLIAM GRAYBILL III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 ALTERNATE 19
PALM HARBOR FL
34683
US

IV. Provider business mailing address

PO BOX 1123
CRYSTAL BEACH FL
34681-1123
US

V. Phone/Fax

Practice location:
  • Phone: 727-785-0375
  • Fax:
Mailing address:
  • Phone: 727-415-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01079292A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number21971
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberFLME 97747
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME97747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: