Provider Demographics
NPI:1003801085
Name:HOUSTON-GRAY, KARLA L (MD)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:L
Last Name:HOUSTON-GRAY
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 1:1000 CARONDELET DR
Mailing Address - Street 2:PROVIDER ENROLLMENT/PHYSICIANS BILLING DEPT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-943-5744
Mailing Address - Fax:816-943-5762
Practice Address - Street 1:1004 CARONDELET DR STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4858
Practice Address - Country:US
Practice Address - Phone:816-942-4500
Practice Address - Fax:816-941-4504
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 109234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208079319Medicaid
KS100454720AMedicaid
MO208079319Medicaid
MON879959Medicare PIN