Provider Demographics
NPI:1790183168
Name:GRAY, GEORGE III (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:GRAY
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2451
Mailing Address - Country:US
Mailing Address - Phone:772-794-2227
Mailing Address - Fax:772-794-9909
Practice Address - Street 1:2000 38TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2451
Practice Address - Country:US
Practice Address - Phone:772-794-2227
Practice Address - Fax:772-794-9909
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine