Provider Demographics
NPI:1962411462
Name:GRAYMAN, DEBRA LAING (MD)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LAING
Last Name:GRAYMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7932 W SAND LAKE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7263
Mailing Address - Country:US
Mailing Address - Phone:407-900-2580
Mailing Address - Fax:407-900-2581
Practice Address - Street 1:7932 W SAND LAKE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7263
Practice Address - Country:US
Practice Address - Phone:407-900-2580
Practice Address - Fax:407-900-2580
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98190207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNPIOther1962411462
FL006347800Medicaid