Provider Demographics
NPI:1649482662
Name:GRAY, LEONARD W (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:W
Last Name:GRAY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:2303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-434-8858
Mailing Address - Fax:415-434-8004
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:2303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-434-8858
Practice Address - Fax:415-434-8004
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG689452086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E-71433Medicare UPIN