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General NPI Number Information
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NPI Number | 1477097251
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Entity Type | Organization
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Legal Business Name | CYNTHIA D GRAY MD PC
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 2101 NE 139TH ST STE 285
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City | VANCOUVER
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State | WA
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Zip | 98686-2326
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Country | US
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Telephone | 360-892-0096
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Fax | 360-892-1962
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Provider Business Mailing Address
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Address Line | 2101 NE 139TH ST STE 285
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City | VANCOUVER
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State | WA
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Zip | 98686-2326
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Country | US
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Telephone | 360-892-0296
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Fax | 360-892-1962
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Authorized Official
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Title or Position | OWNER
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Name | DR. CYNTHIA DEE GRAY
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Credential | MD PC
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Telephone | 360-892-0096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 601876770
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License Number State | WA
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