Provider Demographics
NPI:1942202288
Name:GRAY, DENNIS S (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:S
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:STE 1111
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1462
Mailing Address - Country:US
Mailing Address - Phone:502-456-4100
Mailing Address - Fax:502-459-8454
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:STE 1111
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1462
Practice Address - Country:US
Practice Address - Phone:502-456-4100
Practice Address - Fax:502-459-8454
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY21462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080135036OtherRR MEDICARE
KY50021730OtherPASSPORT
KY6896823OtherCIGNA
KY3633466000OtherPASSPORT ADVANTAGE
KY4380607OtherAETNA
000000600891OtherBC BS
KY64214620Medicaid
KY080135036OtherRR MEDICARE
KY00880001Medicare PIN