Healthcare Provider Details

I. General information

NPI: 1770588873
Provider Name (Legal Business Name): ARTHUR C GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1587 YANCEYVILLE ST
GREENSBORO NC
27405-6933
US

IV. Provider business mailing address

1450 PROFESSIONAL PARK DR STE 150
WINSTON SALEM NC
27103-1307
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-2777
  • Fax: 336-273-1910
Mailing address:
  • Phone: 336-724-2434
  • Fax: 336-607-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036096047
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2018-02557
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: