Provider Demographics
NPI:1851727770
Name:GRAY'S FOOT & ANKLE INC.
Entity Type:Organization
Organization Name:GRAY'S FOOT & ANKLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-919-5663
Mailing Address - Street 1:14117 PECAN HOLLOW TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7257
Mailing Address - Country:US
Mailing Address - Phone:405-919-5663
Mailing Address - Fax:
Practice Address - Street 1:14117 PECAN HOLLOW TER
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7257
Practice Address - Country:US
Practice Address - Phone:405-919-5663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK289261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric