Provider Demographics
NPI:1518355882
Name:GRAY, MARLIN R (MD)
Entity Type:Individual
Prefix:MR
First Name:MARLIN
Middle Name:R
Last Name:GRAY
Suffix:
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 1:925 N. COUNTY RD.
Mailing Address - Street 2:1100E
Mailing Address - City:OTWELL
Mailing Address - State:IN
Mailing Address - Zip Code:47564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:925 N. COUNTY RD.
Practice Address - Street 2:1100E
Practice Address - City:OTWELL
Practice Address - State:IN
Practice Address - Zip Code:47564
Practice Address - Country:US
Practice Address - Phone:812-354-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025358207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine