Provider Demographics
NPI:1225075559
Name:GRAY, PATRICK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ANTHONY
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 1:1240 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-3232
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:305-688-7995
Practice Address - Street 1:20215 NW 2ND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2538
Practice Address - Country:US
Practice Address - Phone:305-652-4542
Practice Address - Fax:305-652-4545
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27432Medicare ID - Type Unspecified
FLF91061Medicare UPIN