Provider Demographics
NPI:1063866085
Name:GRAY, ALICIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-362-3711
Mailing Address - Fax:307-352-8502
Practice Address - Street 1:1200 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5868
Practice Address - Country:US
Practice Address - Phone:307-362-3711
Practice Address - Fax:307-352-8530
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY12107A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine