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General NPI Number Information
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NPI Number | 1245588763
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Entity Type | Individual
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Provider Name | GREGORY LEE GRAY MSN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 902 N WHEELER ST
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City | JASPER
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State | TX
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Zip | 75951-3129
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Country | US
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Telephone | 409-384-4336
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 755
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City | WARREN
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State | TX
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Zip | 77664-0755
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Country | US
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Telephone | 409-289-7727
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 729226
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License Number State | TX
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