Provider Demographics
NPI:1639188527
Name:GRAY, REL LARKIN (MD)
Entity Type:Individual
Prefix:
First Name:REL
Middle Name:LARKIN
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 1:206 E REYNOLDS DRIVE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270
Mailing Address - Country:US
Mailing Address - Phone:318-251-1000
Mailing Address - Fax:318-251-1002
Practice Address - Street 1:206 E REYNOLDS DRIVE
Practice Address - Street 2:SUITE C2
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-251-1000
Practice Address - Fax:318-251-1002
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1119032Medicaid
LA1119032Medicaid
AR52364Medicare ID - Type Unspecified