Healthcare Provider Details

I. General information

NPI: 1730524893
Provider Name (Legal Business Name): TRENT GARRET GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST WEST PAVILION M200
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

9727 INNISBROOK BLVD
CARMEL IN
46032-9270
US

V. Phone/Fax

Practice location:
  • Phone: 317-656-4260
  • Fax:
Mailing address:
  • Phone: 812-599-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11017086A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01076127A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: