Provider Demographics
NPI:1710993985
Name:GRAY, OSCAR TALLY (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:TALLY
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:27880 DORRIS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8581
Mailing Address - Country:US
Mailing Address - Phone:831-626-4469
Mailing Address - Fax:831-626-6041
Practice Address - Street 1:27880 DORRIS DR
Practice Address - Street 2:STE 100
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8581
Practice Address - Country:US
Practice Address - Phone:831-626-4469
Practice Address - Fax:831-626-6041
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA73475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA73475OtherMEDICAL LICENSE
CABG7071715OtherDEA
CAA73475OtherMEDICAL LICENSE
CABG7071715OtherDEA