Provider Demographics
NPI:1700016771
Name:DESHAWNDRANIQUE D. GRAY, M.D., P.A.
Entity Type:Organization
Organization Name:DESHAWNDRANIQUE D. GRAY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DESHAWNDRANIQUE
Authorized Official - Middle Name:DE SHAE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-367-5555
Mailing Address - Street 1:7999 W VIRGINIA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3764
Mailing Address - Country:US
Mailing Address - Phone:214-367-5555
Mailing Address - Fax:214-367-5959
Practice Address - Street 1:7999 W VIRGINIA DR
Practice Address - Street 2:SUITE C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3764
Practice Address - Country:US
Practice Address - Phone:214-367-5555
Practice Address - Fax:214-367-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1721207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI43709Medicare UPIN
TX8L6732Medicare PIN