Provider Demographics
NPI:1235237843
Name:GRAY, KEITH D (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 440251
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0251
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6188
Practice Address - Street 1:1926 ALCOA HWY
Practice Address - Street 2:STE 410
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1512
Practice Address - Country:US
Practice Address - Phone:865-544-9218
Practice Address - Fax:865-305-8262
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN353202086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3864934Medicaid
H51143Medicare UPIN
TN3864934Medicaid