Healthcare Provider Details

I. General information

NPI: 1457322877
Provider Name (Legal Business Name): MICHAEL KEVIN GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 COX CREEK PKWY SUITE A
FLORENCE AL
35630-1105
US

IV. Provider business mailing address

646 COX CREEK PKWY SUITE A
FLORENCE AL
35630-1105
US

V. Phone/Fax

Practice location:
  • Phone: 256-760-1771
  • Fax: 256-760-9149
Mailing address:
  • Phone: 256-760-1771
  • Fax: 256-760-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD0000024535
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number00018908
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: