Healthcare Provider Details

I. General information

NPI: 1710094875
Provider Name (Legal Business Name): JOHN RICHARD GRAYBILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

7703 FLOYD CURL DR MC 7977
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-4000
  • Fax: 210-358-0647
Mailing address:
  • Phone: 210-450-4000
  • Fax: 210-450-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberE3560
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: