Healthcare Provider Details

I. General information

NPI: 1649461823
Provider Name (Legal Business Name): RYAN LANE ALEXANDER GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S JT 9TH FLOOR RESIDENCY OFFICE
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

3107 ENCLAVE LN
FULTONDALE AL
35068-6002
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-6525
  • Fax:
Mailing address:
  • Phone: 409-939-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberN8513
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: