Provider Demographics
NPI:1558552737
Name:GRAY, SYLVIA SUSANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:SUSANA
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2017 W I 35 FRONTAGE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8561
Mailing Address - Country:US
Mailing Address - Phone:405-757-3340
Mailing Address - Fax:405-757-3341
Practice Address - Street 1:2017 W I 35 FRONTAGE RD STE 250
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8561
Practice Address - Country:US
Practice Address - Phone:405-757-3340
Practice Address - Fax:405-757-3341
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK306012086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
4653868865OtherMYUTMB 4653868865