Healthcare Provider Details

I. General information

NPI: 1073752010
Provider Name (Legal Business Name): DR. BRADLEY GEORGE GRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8726 US HIGHWAY 42
FLORENCE KY
41042
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-384-2660
  • Fax: 859-384-5248
Mailing address:
  • Phone: 859-384-2660
  • Fax: 859-384-5248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03150
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: