Provider Demographics
NPI:1659958437
Name:GRAY, STARLIN
Entity Type:Individual
Prefix:
First Name:STARLIN
Middle Name:
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 1:430 NE RAVENNA BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6437
Mailing Address - Country:US
Mailing Address - Phone:206-250-3007
Mailing Address - Fax:
Practice Address - Street 1:2400 NE 95TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2426
Practice Address - Country:US
Practice Address - Phone:206-525-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist