Individual
ROGER DALE GRAYSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 PRAIRIE ST, WINNSBORO, LA 71295-2631
(318) 435-4140
Mailing address
801 PRAIRIE ST, WINNSBORO, LA 71295-2631
(318) 435-4140
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
320306488
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2118218
—
LA
Enumeration date
12/10/2018
Last updated
12/10/2018
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