Provider Demographics
NPI:1497729826
Name:GRAY, GARY D (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5551 WINGHAVEN BLVD
Mailing Address - Street 2:STE 290
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3617
Mailing Address - Country:US
Mailing Address - Phone:636-695-2575
Mailing Address - Fax:314-590-5938
Practice Address - Street 1:5551 WINGHAVEN BLVD
Practice Address - Street 2:STE 290
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3617
Practice Address - Country:US
Practice Address - Phone:636-695-2575
Practice Address - Fax:314-590-5938
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-12-02
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Provider Licenses
StateLicense IDTaxonomies
MO2001028980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60915Medicare UPIN
MOMA3979006Medicare PIN