Healthcare Provider Details

I. General information

NPI: 1730179524
Provider Name (Legal Business Name): DAVID C GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 E INDIANA ST STE 103
EVANSVILLE IN
47715-7448
US

IV. Provider business mailing address

7300 E INDIANA ST STE 103
EVANSVILLE IN
47715-7448
US

V. Phone/Fax

Practice location:
  • Phone: 812-401-8008
  • Fax: 270-886-0392
Mailing address:
  • Phone: 812-401-8008
  • Fax: 270-886-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number43883
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01042305A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: