Provider Demographics
NPI:1598873382
Name:GRAY, CARL R (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:R
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4403 HARRISON BLVD STE 1685
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3274
Mailing Address - Country:US
Mailing Address - Phone:801-476-1777
Mailing Address - Fax:801-479-1479
Practice Address - Street 1:5405 S 500 E STE 202
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-7419
Practice Address - Country:US
Practice Address - Phone:801-476-1777
Practice Address - Fax:801-479-1479
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5553369-1205207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69475Medicare UPIN
0105599703Medicare ID - Type Unspecified