Provider Demographics
NPI:1164429981
Name:GRAY, IROL TORIN (MD)
Entity Type:Individual
Prefix:
First Name:IROL
Middle Name:TORIN
Last Name:GRAY
Suffix:
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 1:500 S UNIVERSITY AVE STE 804
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-907-1710
Mailing Address - Fax:501-907-0914
Practice Address - Street 1:500 S UNIVERSITY AVE STE 804
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-907-1710
Practice Address - Fax:501-907-0914
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1831208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134197001Medicaid
AR17967000000OtherQUALCHOICE
110173743OtherRAILROAD MEDICARE
AR04-20220OtherUNITED HEALTHCARE
AR134197001Medicaid
AR5K748Medicare PIN