Provider Demographics
NPI:1376647362
Name:GRAY, THURMAN ADONIS
Entity Type:Individual
Prefix:MR
First Name:THURMAN
Middle Name:ADONIS
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 STURGEON COURT
Mailing Address - Street 2:STE 121
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001
Mailing Address - Country:US
Mailing Address - Phone:817-375-8822
Mailing Address - Fax:817-375-8883
Practice Address - Street 1:1201 STURGEON COURT
Practice Address - Street 2:STE 121
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001
Practice Address - Country:US
Practice Address - Phone:817-375-8822
Practice Address - Fax:817-375-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2291873Medicaid
TX2291873Medicaid