Provider Demographics
NPI:1417945148
Name:GRAY, CARL W (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:W
Last Name:GRAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22390
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-2390
Mailing Address - Country:US
Mailing Address - Phone:800-235-1415
Mailing Address - Fax:913-234-1108
Practice Address - Street 1:11401 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7042
Practice Address - Country:US
Practice Address - Phone:501-455-7100
Practice Address - Fax:501-455-7399
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00604367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
59681OtherBCBS AR
P00195200OtherRR MEDICARE
59681OtherBCBS AR
AR59681C752Medicare PIN
AR59681Medicare ID - Type Unspecified