Provider Demographics
NPI:1538505052
Name:GRAY, DELMAR (CSFA)
Entity Type:Individual
Prefix:
First Name:DELMAR
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:DELMAR
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSFA
Mailing Address - Street 1:1803 S JACKSON AVE APT 27E
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-1863
Mailing Address - Country:US
Mailing Address - Phone:918-813-7486
Mailing Address - Fax:
Practice Address - Street 1:1803 S JACKSON AVE APT 27E
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-1863
Practice Address - Country:US
Practice Address - Phone:918-813-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK139945246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant