Provider Demographics
NPI:1427026566
Name:GRAY, MARCUS LAMAR
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:LAMAR
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 1:1101 LOWELLA AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3465
Mailing Address - Country:US
Mailing Address - Phone:808-590-0362
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER USS LA JOLLA SSN 701
Practice Address - Street 2:ATTN MED DEPT
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96671-2381
Practice Address - Country:US
Practice Address - Phone:808-471-5002
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman