Individual
ROGER C GRAYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC MPAB
Contact information
Practice address
419 SOUTH L STREET SUITE 101, TACOMA, WA 98405
(253) 383-5949
(253) 383-5953
Mailing address
419 SOUTH L STREET SUITE 101, TACOMA, WA 98405
(253) 383-5949
(253) 383-5953
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1784206
PREMERA BLUE CROSS
WA
05
—
8357030
—
WA
01
—
GAB25485
MEDICARE PIERCE COUNTY
WA
01
—
GR6977
REGENCE BLUE SHIELD
WA
Enumeration date
11/02/2006
Last updated
11/21/2007
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