Healthcare Provider Details

I. General information

NPI: 1013947142
Provider Name (Legal Business Name): ANGELA LORRAINE GRAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S J ST FL 1
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1608 S J ST FL 1
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-7501
  • Fax: 206-246-0468
Mailing address:
  • Phone: 253-274-7501
  • Fax: 206-246-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME117908
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2015-00395
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD60930373
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: