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1487117867 NPI number — LAUREL S. GRAY MD, MS

NPI Number: 1487117867
Health Care Provider/Practitioner: LAUREL S. GRAY MD, MS

Information about “1487117867” NPI (LAUREL S. GRAY MD, MS) exists in 1487117867 in HTML format HTML  |  1487117867 in plain Text format TXT  |  1487117867 in PDF (Portable Document Format) PDF  |  1487117867 in an XML format XML  formats.

NPI Number : 1487117867 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487117867",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRAY",
    "FirstName": "LAUREL",
    "MiddleName": "S.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD, MS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "30 N 1900 E RM 4A330",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84132-0002",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-581-6465",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1490 N TURQUOISE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FLAGSTAFF",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86001-1383",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "928-774-5074",
    "PracticeLocationAddressFaxNumber": "928-779-0884",
    "EnumerationDate": "04/11/2019",
    "LastUpdateDate": "06/09/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "11921064-1205",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "76946",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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