Individual
WAYNE DAVID GRAVOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 NORTH BLVD STE 200, BATON ROUGE, LA 70806-3743
(225) 381-6620
(225) 819-1179
Mailing address
3401 NORTH BLVD STE 200, BATON ROUGE, LA 70806-3743
(225) 381-6620
(225) 819-1179
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
016200
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1338915
—
LA
Enumeration date
07/28/2005
Last updated
10/03/2019
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