Provider Demographics
NPI:1467506378
Name:GRAY, MARSHA KAY
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:KAY
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16075 STATE ROUTE BB
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-7160
Mailing Address - Country:US
Mailing Address - Phone:573-265-4729
Mailing Address - Fax:573-265-7861
Practice Address - Street 1:16075 STATE ROUTE BB
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-7160
Practice Address - Country:US
Practice Address - Phone:573-265-4729
Practice Address - Fax:573-265-7861
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor