Provider Demographics
NPI:1841375284
Name:GRAY, GERALD GENE (DO)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:GENE
Last Name:GRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:OAKLAND CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47660-0037
Mailing Address - Country:US
Mailing Address - Phone:812-677-1244
Mailing Address - Fax:812-749-3765
Practice Address - Street 1:HWY 64 WEST
Practice Address - Street 2:
Practice Address - City:OAKLAND CITY
Practice Address - State:IN
Practice Address - Zip Code:47660-0037
Practice Address - Country:US
Practice Address - Phone:812-677-1244
Practice Address - Fax:812-749-3765
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000256A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E33543Medicare UPIN