Provider Demographics
NPI:1073694154
Name:PATRICK GRAY OBSTETRICS & GYNECOLOGY, PC
Entity Type:Organization
Organization Name:PATRICK GRAY OBSTETRICS & GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:HAMPTON
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-892-0200
Mailing Address - Street 1:103 HUNT DR
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4987
Mailing Address - Country:US
Mailing Address - Phone:910-892-0200
Mailing Address - Fax:
Practice Address - Street 1:103 HUNT DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4987
Practice Address - Country:US
Practice Address - Phone:910-892-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27683174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0260EOtherBLUE CROSS BLUE SHIELD NC
NC89-0260EMedicaid
NC89-0260EMedicaid
NCC84153Medicare UPIN