Individual
GRALYN TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
5197
SC
Other
Enumeration date
12/06/2023
Last updated
05/14/2024
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