MEDICARE: GLEN GRAYMAN 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	207P00000X	Emergency Medicine Physician	A44131	CA

General Provider Information

NPI Number	:	1932142007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN GRAYMAN M.D

Provider Business Mailing Address
First Line	:	2100 POWELL ST
Second Line	:	STE 920
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1826
Country	:	US
Telephone Number	:	510-350-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	69175 RAMON RD BLDG A
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3344
Country	:	US
Telephone Number	:	760-323-6251
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	05/19/2015

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