Healthcare Provider Details

I. General information

NPI: 1861481517
Provider Name (Legal Business Name): KRISTEN DAVID GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 TOWNE CENTER BLVD
SANFORD FL
32771-7407
US

IV. Provider business mailing address

401 TOWNE CENTER BLVD
SANFORD FL
32771-7407
US

V. Phone/Fax

Practice location:
  • Phone: 407-200-0547
  • Fax:
Mailing address:
  • Phone: 407-200-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80188
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME85090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: