Healthcare Provider Details

I. General information

NPI: 1679526891
Provider Name (Legal Business Name): CHRISTA LYNN GRAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

1109 COWPER DR
RALEIGH NC
27608-2230
US

V. Phone/Fax

Practice location:
  • Phone: 919-873-9533
  • Fax: 919-873-9821
Mailing address:
  • Phone: 919-609-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA82099
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA82099
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA82099
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200601829
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: