Healthcare Provider Details

I. General information

NPI: 1053160689
Provider Name (Legal Business Name): DAVID MILTON GRAY DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

320 SUNSET AVE
BATESVILLE IN
47006-1018
US

V. Phone/Fax

Practice location:
  • Phone: 812-934-6624
  • Fax:
Mailing address:
  • Phone: 812-727-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28248581A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: