Healthcare Provider Details

I. General information

NPI: 1407310253
Provider Name (Legal Business Name): DEMIAN EMIL GRAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 891 KM 15.1
COROZAL PR
00783
US

IV. Provider business mailing address

1047 CALLE 9 SE
SAN JUAN PR
00921-3124
US

V. Phone/Fax

Practice location:
  • Phone: 787-859-2560
  • Fax:
Mailing address:
  • Phone: 787-690-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24013
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: