Healthcare Provider Details

I. General information

NPI: 1386762052
Provider Name (Legal Business Name): EDWARD E.GRAUL,JR, MD, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MOOSA BLVD
EUNICE LA
70535-3638
US

IV. Provider business mailing address

251 MOOSA BLVD
EUNICE LA
70535-3638
US

V. Phone/Fax

Practice location:
  • Phone: 337-457-1638
  • Fax: 337-457-1656
Mailing address:
  • Phone: 337-457-1638
  • Fax: 337-457-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14875
License Number StateLA

VIII. Authorized Official

Name: DR. EDWARD EUGENE GRAUL JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 337-457-1638