Provider Demographics
NPI:1366222978
Name:GRAYSON, CASEY BRYANT
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:BRYANT
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10066 JUDY AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3523
Mailing Address - Country:US
Mailing Address - Phone:410-599-0149
Mailing Address - Fax:
Practice Address - Street 1:10066 JUDY AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3523
Practice Address - Country:US
Practice Address - Phone:410-599-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant