Provider Demographics
NPI:1659578706
Name:GRAY HAZARD, FLORETTE K (MD)
Entity type:Individual
Prefix:
First Name:FLORETTE
Middle Name:K
Last Name:GRAY HAZARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FLORETTE
Other - Middle Name:KIMBERLY
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4400 V ST RM 1106A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 V ST RM 1106A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1445
Practice Address - Country:US
Practice Address - Phone:916-734-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431540207ZP0102X, 207ZP0213X
CAA86052207ZP0213X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology