Provider Demographics
NPI:1033283155
Name:GRAY, DALTON L II (MD)
Entity Type:Individual
Prefix:DR
First Name:DALTON
Middle Name:L
Last Name:GRAY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0550
Mailing Address - Country:US
Mailing Address - Phone:479-463-7775
Mailing Address - Fax:479-468-7187
Practice Address - Street 1:3 E APPLEBY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-404-1010
Practice Address - Fax:479-404-1011
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC-6610207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD04580Medicare UPIN