Healthcare Provider Details

I. General information

NPI: 1851727770
Provider Name (Legal Business Name): GRAY'S FOOT & ANKLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14117 PECAN HOLLOW TER
EDMOND OK
73013-7257
US

IV. Provider business mailing address

14117 PECAN HOLLOW TER
EDMOND OK
73013-7257
US

V. Phone/Fax

Practice location:
  • Phone: 405-919-5663
  • Fax:
Mailing address:
  • Phone: 405-919-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number289
License Number StateOK

VIII. Authorized Official

Name: DR. JEREMY DALE GRAY
Title or Position: PRESIDENT/CEO
Credential: D.P.M.
Phone: 405-919-5663