Provider Demographics
NPI:1588659098
Name:SWOR, GRAY B (MD)
Entity Type:Individual
Prefix:
First Name:GRAY
Middle Name:B
Last Name:SWOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GRAY
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3210 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6411
Practice Address - Country:US
Practice Address - Phone:941-364-8887
Practice Address - Fax:941-954-3222
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00798662085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202973OtherWELLCARE PROVIDER NUMBER
FL284809OtherAVMED PROVIDER NUMBER
FL5593558OtherAETNA PROVIDER NUMBER
FLME79866AOtherMETCARE PROVIDER ID #
FL144024-01OtherCITRUS HLTHCR PROV. #
FL5899OtherAVMED PIN NUMBER
FL100174OtherOP. ENG. LOC. 825 PROV. #
FL5196343-007OtherCIGNA PROVIDER NUMBER
FL207227OtherAMERIGROUP GROUP #
FL202973OtherWELLCARE PROVIDER NUMBER
FL5196343-007OtherCIGNA PROVIDER NUMBER