Healthcare Provider Details

I. General information

NPI: 1790754398
Provider Name (Legal Business Name): NEAL HADLEY GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

17 INWOOD AUTUMN
SAN ANTONIO TX
78248-1679
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-2118
  • Fax:
Mailing address:
  • Phone: 210-764-2203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberE 2017
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: