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Individual
MR. WAYNE C GRAVELL
Active
Individual
MR. WAYNE C GRAVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00402959002
BLUE SHIELD NENY
—
01
—
040426007412
FIDELIS
NY
01
—
10051937
CD PHP
—
01
—
421559943
UNITED HEALTH CARE
—
Enumeration date
01/18/2006
Last updated
06/05/2008
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