Provider Demographics
NPI:1669004461
Name:GRAY, BRIJETTE ANN (AA)
Entity Type:Individual
Prefix:
First Name:BRIJETTE
Middle Name:ANN
Last Name:GRAY
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 JACK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5927
Mailing Address - Country:US
Mailing Address - Phone:208-881-6339
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST STE 5.181
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-5228
Practice Address - Fax:713-500-0648
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32697618207L00000X, 367H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program