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General NPI Number Information
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NPI Number | 1023066495
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Entity Type | Individual
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Provider Name | BRUCE HARVEY GRAY D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 200 PATEWOOD DR SUITE C300
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City | GREENVILLE
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State | SC
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Zip | 29615-3557
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Country | US
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Telephone | 864-454-8272
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Fax | 864-454-2875
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 606
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0606
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License Number State | SC
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