Provider Demographics
NPI:1497885990
Name:GRAY, JOHN WILLIAM III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:GRAY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 OLD JERICHO RD
Mailing Address - Street 2:PO BOX 4037
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29903
Mailing Address - Country:US
Mailing Address - Phone:843-524-0255
Mailing Address - Fax:
Practice Address - Street 1:116 OLD JERICHO RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5119
Practice Address - Country:US
Practice Address - Phone:843-524-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine