Healthcare Provider Details

I. General information

NPI: 1346354297
Provider Name (Legal Business Name): JACQUELINE J GRAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HOSPITAL DR STE 420
BOSSIER CITY LA
71111-2166
US

IV. Provider business mailing address

243 CURTISS RD STE 100
BARKSDALE AFB LA
71110-2425
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7880
  • Fax:
Mailing address:
  • Phone: 318-456-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35075835
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number301878
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: