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General NPI Number Information
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NPI Number | 1346354297
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Entity Type | Individual
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Provider Name | JACQUELINE J GRAY MD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 2300 HOSPITAL DR STE 420
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2166
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Country | US
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Telephone | 318-212-7880
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Fax |
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Provider Business Mailing Address
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Address Line | 243 CURTISS RD STE 100
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City | BARKSDALE AFB
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State | LA
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Zip | 71110-2425
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Country | US
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Telephone | 318-456-6555
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35075835
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 301878
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License Number State | LA
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