Provider Demographics
NPI:1669585915
Name:GRAY, LARA ROYSTER (AUD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:ROYSTER
Last Name:GRAY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
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Mailing Address - Street 1:857 S BECKFORD DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-3486
Mailing Address - Country:US
Mailing Address - Phone:252-430-7744
Mailing Address - Fax:252-430-0917
Practice Address - Street 1:857 S BECKFORD DR
Practice Address - Street 2:SUITE H
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3486
Practice Address - Country:US
Practice Address - Phone:252-430-7744
Practice Address - Fax:252-430-0917
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4578237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11852OtherBCBS OF NC
NC56-2260112AOtherCIGNA HEALTHSOURCE
NC7001565Medicaid
NC56-2260112OtherMARIA PARHAM HOSPITAL
NC7400006Medicaid
NC7411476Medicaid
NC85707OtherMECOST
NC56-2260112OtherCIGNA HEALTHCARE
NC56-2260112OtherPAXTON MEDICAL GROUP
NC56-2260112OtherIDEAL FASTENERS
NC56-2260112OtherGRANVILLE MEDICAL CENTER
NC640004163OtherRAILROAD MEDICARE
NC3404255Medicaid
NC7211020Medicaid
NC56-2260112OtherCIGNA HEALTHCARE
NC7001565Medicaid
NC7400006Medicaid
NC2520834DMedicare PIN