Provider Demographics
NPI:1619952033
Name:GRAY, ROBERT M (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
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 1:115 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-3413
Mailing Address - Country:US
Mailing Address - Phone:256-245-3267
Mailing Address - Fax:
Practice Address - Street 1:115 W CLAY ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-3413
Practice Address - Country:US
Practice Address - Phone:256-245-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist