MEDICARE: DR. PATRICK ANTHONY GRAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0068131	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225075559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK ANTHONY GRAY MD

Provider Business Mailing Address
First Line	:	1240 NW 119TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33167-3232
Country	:	US
Telephone Number	:	305-685-5688
Fax Number	:	305-688-7995

Provider Business Practice Location Address
First Line	:	20215 NW 2ND AVE
Second Line	:	SUITE 1
City	:	MIAMI
State	:	FL
Zip	:	33169-2538
Country	:	US
Telephone Number	:	305-652-4542
Fax Number	:	305-652-4545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	12/13/2011

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