Provider Demographics
NPI:1831153824
Name:GRAY, ANN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 E 30TH ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-1331
Mailing Address - Country:US
Mailing Address - Phone:816-665-3454
Mailing Address - Fax:
Practice Address - Street 1:2305 S HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7431
Practice Address - Fax:660-831-3314
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112737207Q00000X
KS04-28795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCD6440OtherMEDICARE RAILROAD GRP #
KSP00125145OtherMEDICARE RAILROAD PIN
KSC888490Medicare PIN
KSP00125145OtherMEDICARE RAILROAD PIN