Provider Demographics
NPI:1770598831
Name:GRAY, NADEEN W (MD)
Entity type:Individual
Prefix:MISS
First Name:NADEEN
Middle Name:W
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5701 W SLAUGHTER LN
Mailing Address - Street 2:BLDG C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-6527
Mailing Address - Country:US
Mailing Address - Phone:512-901-4479
Mailing Address - Fax:512-901-3945
Practice Address - Street 1:5701 W SLAUGHTER LN
Practice Address - Street 2:BLDG. C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-6527
Practice Address - Country:US
Practice Address - Phone:512-901-4031
Practice Address - Fax:512-334-2589
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2022-01-26
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Provider Licenses
StateLicense IDTaxonomies
TXK5031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103515603Medicaid
TX103515604Medicaid
TX103515602Medicaid
TX8653J0Medicare PIN
TX080148200Medicare PIN
TX103515602Medicaid
TX81728KMedicare PIN