Provider Demographics
NPI:1114063732
Name:GRAY, PAUL LAWRENCE (DPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:LAWRENCE
Last Name:GRAY
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7008
Mailing Address - Country:US
Mailing Address - Phone:405-799-3178
Mailing Address - Fax:
Practice Address - Street 1:1108 NW 18TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6002
Practice Address - Country:US
Practice Address - Phone:405-524-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist