Healthcare Provider Details

I. General information

NPI: 1871882159
Provider Name (Legal Business Name): WILLIAM B GRAY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 UNIVERSITY PKWY SUITE 407
PENSACOLA FL
32514-5752
US

IV. Provider business mailing address

PO BOX 17567
PENSACOLA FL
32522-7567
US

V. Phone/Fax

Practice location:
  • Phone: 850-916-8700
  • Fax:
Mailing address:
  • Phone: 850-916-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS13615
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: