Provider Demographics
NPI:1821383134
Name:GRAY, DAVID WATERHOUSE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WATERHOUSE
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 1:612 DRUID RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3912
Mailing Address - Country:US
Mailing Address - Phone:727-443-6400
Mailing Address - Fax:727-443-5590
Practice Address - Street 1:612 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3912
Practice Address - Country:US
Practice Address - Phone:727-443-6400
Practice Address - Fax:727-443-5590
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133561207RR0500X
MA248869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME133561OtherFLORIDA BOARD OF MEDICINE