Provider Demographics
NPI:1689764110
Name:GRAY, GENA C (MD)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:C
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5636
Mailing Address - Country:US
Mailing Address - Phone:918-712-8700
Mailing Address - Fax:
Practice Address - Street 1:1919 S WHEELING AVE STE 700
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5636
Practice Address - Country:US
Practice Address - Phone:918-712-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19039207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2782906OtherCIGNA
OKF-61049Medicare UPIN
OK2148141OtherAETNA