Provider Demographics
NPI:1508060179
Name:GRAY, LAURIE P (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:P
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 WILLAGILLESPIE RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2186
Mailing Address - Country:US
Mailing Address - Phone:541-484-5437
Mailing Address - Fax:541-484-0155
Practice Address - Street 1:995 WILLAGILLESPIE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2186
Practice Address - Country:US
Practice Address - Phone:541-484-5437
Practice Address - Fax:541-484-0155
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9326208000000X
ORMD213086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203916604OtherCSHCN
TX1750369203OtherNPI GROUP NUMBER
TX203916603Medicaid
2776658177OtherMYUTMB 2776658177-COMMERCIAL NUMBER
2776658177OtherMYUTMB 2776658177-COMMERCIAL NUMBER