Provider Demographics
NPI:1649461823
Name:GRAY, RYAN LANE ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LANE ALEXANDER
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 1:3107 ENCLAVE LN
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-6002
Mailing Address - Country:US
Mailing Address - Phone:409-939-0500
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:JT 9TH FLOOR RESIDENCY OFFICE
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-934-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8513207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4663377831OtherMYUTMB 4663377831