Individual
RAYNA GRAVATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2301 HOUSE AVE, SUITE 405, CHEYENNE, WY 82001-3176
(307) 635-7961
(307) 637-8300
Mailing address
PO BOX 20970, CHEYENNE, WY 82003-7020
(307) 635-7961
(307) 778-5812
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
7676A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962624049
—
WY
Enumeration date
05/02/2007
Last updated
07/31/2013
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