Healthcare Provider Details

I. General information

NPI: 1760346639
Provider Name (Legal Business Name): WILLIAM GRAYSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 N ROCKWELL AVE APT 4208
OKLAHOMA CITY OK
73132-5857
US

IV. Provider business mailing address

7400 N ROCKWELL AVE APT 4208
OKLAHOMA CITY OK
73132-5857
US

V. Phone/Fax

Practice location:
  • Phone: 949-979-9162
  • Fax:
Mailing address:
  • Phone: 949-979-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: