Provider Demographics
NPI:1114145554
Name:GRAY, LEE V III (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:V
Last Name:GRAY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16511 NORTHCROSS DR STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5021
Mailing Address - Country:US
Mailing Address - Phone:704-896-3313
Mailing Address - Fax:
Practice Address - Street 1:16511 NORTHCROSS DR STE A
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5021
Practice Address - Country:US
Practice Address - Phone:704-896-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400340207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI25936Medicare UPIN
NCI25936Medicare UPIN
NCBG8868513OtherDEA