Provider Demographics
NPI:1326033887
Name:GRAY, STEVEN H (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
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 1:9720 PARK PLAZA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2288
Mailing Address - Country:US
Mailing Address - Phone:502-410-5788
Mailing Address - Fax:502-339-4531
Practice Address - Street 1:9720 PARK PLAZA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2288
Practice Address - Country:US
Practice Address - Phone:502-410-5788
Practice Address - Fax:502-339-4531
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057382A207Q00000X
KY36976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200423160Medicaid
IN200423160Medicaid
IN241470NMedicare ID - Type Unspecified
INM400038386Medicare PIN