Provider Demographics
NPI:1245316637
Name:GRAY, THOMAS L (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
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 1:7705 POPLAR AVENUE, SUITE 240
Mailing Address - Street 2:PROFESSIONAL BLDG. B
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-791-9800
Mailing Address - Fax:901-791-9801
Practice Address - Street 1:7705 POPLAR AVENUE, SUITE 240
Practice Address - Street 2:PROFESSIONAL BLDG. B
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-791-9800
Practice Address - Fax:901-791-9801
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD011103207V00000X
ARR3349207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121792Medicaid
7440190OtherUNITED HEALTHCARE
MS9015197Medicaid
84653OtherBLUE CROSS BLUE SHIELD
AR102019001Medicaid
TN3190533Medicaid
5312713OtherCIGNA
0089362OtherBLUE CROSS BLUE SHIELD
MS9015197Medicaid
5312713OtherCIGNA