Provider Demographics
NPI:1598949372
Name:GRAY, ELBERT F
Entity Type:Individual
Prefix:MR
First Name:ELBERT
Middle Name:F
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4549
Mailing Address - Country:US
Mailing Address - Phone:281-446-4462
Mailing Address - Fax:281-446-2464
Practice Address - Street 1:309 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4549
Practice Address - Country:US
Practice Address - Phone:281-446-4462
Practice Address - Fax:281-446-2464
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009545251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679583Medicare Oscar/Certification