Provider Demographics
NPI:1821040353
Name:GRAY, WALTER JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JAMES
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-5820
Practice Address - Fax:317-962-0500
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43081207RC0200X
IN01088744A207RC0200X
NC2014-02018207RC0200X
WV31668207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE82638Medicare UPIN
FL263907600Medicare ID - Type Unspecified
FL23428YMedicare ID - Type Unspecified
FL23428WMedicare PIN