Healthcare Provider Details

I. General information

NPI: 1760752240
Provider Name (Legal Business Name): DAVID ELBERT GRAYSON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17625 SE 45TH PL
BELLEVUE WA
98006-6520
US

IV. Provider business mailing address

17625 SE 45TH PLACE
BELLEVUE WA
98006-6520
US

V. Phone/Fax

Practice location:
  • Phone: 206-954-4444
  • Fax:
Mailing address:
  • Phone: 206-954-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberFE0247684
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: