Healthcare Provider Details

I. General information

NPI: 1710993985
Provider Name (Legal Business Name): OSCAR TALLY GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27880 DORRIS DR STE 100
CARMEL CA
93923-8581
US

IV. Provider business mailing address

27880 DORRIS DR STE 100
CARMEL CA
93923-8581
US

V. Phone/Fax

Practice location:
  • Phone: 831-626-4469
  • Fax: 831-626-6041
Mailing address:
  • Phone: 831-626-4469
  • Fax: 831-626-6041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA73475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: