Individual
DR. GRAYDEN WOODRUFF KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
831 NW COUNCIL DR, STE 203, GRESHAM, OR 97030-3721
(503) 667-6600
(503) 667-6608
Mailing address
831 NW COUNCIL DR, STE 203, GRESHAM, OR 97030-3721
(503) 667-6600
(503) 667-6608
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DP 00436
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377694001
—
TX
05
—
377694002
—
TX
01
—
R141926
MEDICARE PTAN
OR
Enumeration date
09/18/2007
Last updated
12/28/2017
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