Provider Demographics
NPI:1346643459
Name:B LYNNE GRAY MD PLLC
Entity Type:Organization
Organization Name:B LYNNE GRAY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-219-8991
Mailing Address - Street 1:12505 HYMEADOW DR
Mailing Address - Street 2:SUITE 2-A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1867
Mailing Address - Country:US
Mailing Address - Phone:512-219-8991
Mailing Address - Fax:512-219-8996
Practice Address - Street 1:12505 HYMEADOW DR
Practice Address - Street 2:SUITE 2-A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1867
Practice Address - Country:US
Practice Address - Phone:512-219-8991
Practice Address - Fax:512-219-8996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8145261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care