Provider Demographics
NPI:1588666317
Name:GRAY, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
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 1:811 W COOMER ST
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:MI
Mailing Address - Zip Code:49256-1352
Mailing Address - Country:US
Mailing Address - Phone:517-458-6109
Mailing Address - Fax:517-458-6131
Practice Address - Street 1:811 W COOMER ST
Practice Address - Street 2:
Practice Address - City:MORENCI
Practice Address - State:MI
Practice Address - Zip Code:49256-1352
Practice Address - Country:US
Practice Address - Phone:517-458-6109
Practice Address - Fax:517-458-6131
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065541208000000X
MI4310165541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2409558Medicaid
MI4999987Medicaid
MI04-07759OtherUHC
MI7917019OtherAETNA
MI04286OtherPHC
MI142870OtherGLHP
MIP00025330OtherRRMC
MI23267OtherHPM
MI4494722Medicaid
MI1104607522OtherBCBS MI
MI131372OtherPREFERRED CHOICES
MI000000358054OtherANTHEM
MI131372OtherCARE CHOICES
161036OtherGLHP
MI7917019OtherAETNA
MI142870OtherGLHP