MEDICARE: DR. RICHARD JOSEPH GRAYSON JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	0101020808	VA

General Provider Information

NPI Number	:	1871698704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JOSEPH GRAYSON JR. M.D.

Provider Business Mailing Address
First Line	:	2609 ROBIN HOOD RD SE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-3421
Country	:	US
Telephone Number	:	540-344-1067
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 ROBIN HOOD RD SE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-3421
Country	:	US
Telephone Number	:	540-344-1067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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