Provider Demographics
NPI:1134154941
Name:GRAY, DEVIN LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:LYNN
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:DEVIN
Other - Middle Name:LYNN
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD FACS
Mailing Address - Street 1:2558 S RIATA CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5948
Mailing Address - Country:US
Mailing Address - Phone:480-892-2456
Mailing Address - Fax:480-892-2458
Practice Address - Street 1:4135 S POWER RD
Practice Address - Street 2:STE 117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3624
Practice Address - Country:US
Practice Address - Phone:480-892-2456
Practice Address - Fax:480-892-2458
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22813208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00091989OtherRR MEDICARE
AZ1Z0654OtherHEAL;THNET AZ
AZ339110Medicaid
AZF11833Medicaid
AZAZ0891430OtherBCBS AZ
AZAZ0891430OtherBCBS AZ
AZP00091989OtherRR MEDICARE