Provider Demographics
NPI:1477097251
Name:CYNTHIA D GRAY MD PC
Entity Type:Organization
Organization Name:CYNTHIA D GRAY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:360-892-0096
Mailing Address - Street 1:2101 NE 139TH ST STE 285
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2326
Mailing Address - Country:US
Mailing Address - Phone:360-892-0296
Mailing Address - Fax:360-892-1962
Practice Address - Street 1:2101 NE 139TH ST STE 285
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2326
Practice Address - Country:US
Practice Address - Phone:360-892-0096
Practice Address - Fax:360-892-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601876770261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty