Provider Demographics
NPI:1922110311
Name:GRAY, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-4405
Practice Address - Fax:682-885-4407
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1964207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225575OtherUHC PIN
TX124207OtherSUPERIOR PIN
TX4543955OtherAETNA PIN
TX10012682OtherAMERIGROUP PIN
TX102106OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER
TX142203206OtherCSHCN
TX00U87ZOtherBCBSTX GRP PIN
TX2840740OtherCIGNA PIN
TX88892XOtherBCBSTX IND PIN
TX281772OtherPHCS PIN
TX113937100OtherFIRSTCARE PIN
TX142203205Medicaid
TX10012682OtherAMERIGROUP PIN
TX102106OtherFIRSTHEALTH PIN