Provider Demographics
NPI:1003841909
Name:GRAY, BARBARA LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LYNNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 HYMEADOW DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1867
Mailing Address - Country:US
Mailing Address - Phone:512-219-8991
Mailing Address - Fax:512-219-8996
Practice Address - Street 1:12505 HYMEADOW DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1867
Practice Address - Country:US
Practice Address - Phone:512-219-8991
Practice Address - Fax:512-219-8996
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX376447ZKPTOtherPTAN
TX00DK51Medicare ID - Type Unspecified
TX376447ZKPTOtherPTAN