Healthcare Provider Details

I. General information

NPI: 1144661588
Provider Name (Legal Business Name): ELIZABETH A GRAY MEDICAL STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SW 13TH ST
GAINESVILLE FL
32608-4006
US

IV. Provider business mailing address

4300 SW 13TH ST
GAINESVILLE FL
32608-4006
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-5600
  • Fax: 352-374-5608
Mailing address:
  • Phone: 352-374-5600
  • Fax: 352-374-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberLL96753
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: