Provider Demographics
NPI:1225139793
Name:GRAY, KAREN JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JANE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 NICHOLE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4487
Mailing Address - Country:US
Mailing Address - Phone:501-658-1111
Mailing Address - Fax:
Practice Address - Street 1:1671 NICHOLE WOODS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-4487
Practice Address - Country:US
Practice Address - Phone:501-658-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4840207R00000X, 208000000X
TXN2094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163221001Medicaid
AR06070016400OtherQUALCHOICE
AR5N571Medicare ID - Type Unspecified
AR163221001Medicaid
ARI67594Medicare UPIN