Provider Demographics
NPI:1740461177
Name:DAVID J GRAY PC
Entity type:Organization
Organization Name:DAVID J GRAY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-265-7957
Mailing Address - Street 1:910 ADAMS ST SE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3730
Mailing Address - Country:US
Mailing Address - Phone:256-265-7957
Mailing Address - Fax:256-265-7965
Practice Address - Street 1:910 ADAMS ST SE
Practice Address - Street 2:SUITE 130
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3730
Practice Address - Country:US
Practice Address - Phone:256-265-7957
Practice Address - Fax:256-265-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25672208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51519686OtherMEDICARE
AL51519686Medicaid
AL51519686Medicaid