Healthcare Provider Details

I. General information

NPI: 1598083719
Provider Name (Legal Business Name): GEORGE WILLIAM GRAY JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 38TH AVE
VERO BEACH FL
32960-2451
US

IV. Provider business mailing address

2000 38TH AVE
VERO BEACH FL
32960-2451
US

V. Phone/Fax

Practice location:
  • Phone: 772-794-2227
  • Fax: 772-794-9909
Mailing address:
  • Phone: 772-794-2227
  • Fax: 772-794-9909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME44475
License Number StateFL

VIII. Authorized Official

Name: RACHEL GLENTON
Title or Position: OFFICE MANAGER/BILLING
Credential:
Phone: 772-794-2227