Healthcare Provider Details

I. General information

NPI: 1154306975
Provider Name (Legal Business Name): RANDY SCOTT GRAY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RANDY GRAY DC

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 DEAHL ST
BORGER TX
79007-4707
US

IV. Provider business mailing address

PO BOX 1127
BORGER TX
79008-1127
US

V. Phone/Fax

Practice location:
  • Phone: 806-273-3366
  • Fax: 806-273-2532
Mailing address:
  • Phone: 806-273-3366
  • Fax: 806-273-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6368
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: