Provider Demographics
NPI:1336637859
Name:GRAY, JENNIFER LEANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W 11TH PL STE 200
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4121
Mailing Address - Country:US
Mailing Address - Phone:432-264-7180
Mailing Address - Fax:
Practice Address - Street 1:1501 W 11TH PL STE 200
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4121
Practice Address - Country:US
Practice Address - Phone:857-304-2644
Practice Address - Fax:617-562-5313
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT8215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10065230OtherTEXAS PIT PERMIT