Provider Demographics
NPI:1003044421
Name:GRAY, RICHARD E (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:GRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 SCOTT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:JBPH-HICKAM
Mailing Address - State:HI
Mailing Address - Zip Code:96253
Mailing Address - Country:US
Mailing Address - Phone:808-448-6177
Mailing Address - Fax:
Practice Address - Street 1:755 SCOTT CIRCLE
Practice Address - Street 2:
Practice Address - City:JBPH-HICKAM
Practice Address - State:HI
Practice Address - Zip Code:96253-5399
Practice Address - Country:US
Practice Address - Phone:808-448-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-056918207Q00000X
NE824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine