Provider Demographics
NPI:1790798619
Name:GRAY, JENNIFER DENISE (MD)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:DENISE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2017 BROADWAY ST
Mailing Address - Street 2:STE. A
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5501
Mailing Address - Country:US
Mailing Address - Phone:281-485-9990
Mailing Address - Fax:281-485-9469
Practice Address - Street 1:2017 BROADWAY ST
Practice Address - Street 2:STE. A
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5501
Practice Address - Country:US
Practice Address - Phone:281-485-9990
Practice Address - Fax:281-485-9469
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM4118208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics