Provider Demographics
NPI:1194826677
Name:GRAY, RICKEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKEY
Middle Name:C
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 1:4313 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4023
Mailing Address - Country:US
Mailing Address - Phone:501-686-9000
Mailing Address - Fax:501-686-9070
Practice Address - Street 1:4313 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4023
Practice Address - Country:US
Practice Address - Phone:501-686-9000
Practice Address - Fax:501-686-9070
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-45942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06070016500OtherQUALCHOICE
ARP00361481OtherRAILROAD MEDICARE
AR5N586Medicare ID - Type Unspecified
ARP00361481OtherRAILROAD MEDICARE