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General NPI Number Information
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NPI Number | 1285813436
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Entity Type | Organization
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Legal Business Name | JOHN P GRAY MD PA
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 1204 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4027
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Country | US
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Telephone | 936-462-7844
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Fax | 936-462-7855
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Provider Business Mailing Address
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Address Line | 4100 INTERNATIONAL PLAZA SUITE 600
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City | FORT WORTH
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State | TX
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Zip | 76109-4823
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Country | US
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Telephone | 817-334-0530
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Fax | 817-877-0350
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Authorized Official
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Title or Position | OWNER
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Name | JOHN P GRAY
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Credential | MD
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Telephone | 936-675-1065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | K7025
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License Number State | TX
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