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General NPI Number Information
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NPI Number | 1649253527
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Entity Type | Individual
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Provider Name | JENNIFER JANE GRAY MD
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Gender | Female
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 225 NATCHEZ TRACE AVENUE
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City | BOWLING GREEN
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State | KY
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Zip | 42103
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Country | US
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Telephone | 270-783-3573
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Fax | 270-783-4081
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Provider Business Mailing Address
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Address Line | PO BOX 1177
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City | BOWLING GREEN
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State | KY
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Zip | 42102-1177
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Country | US
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Telephone | 270-783-3573
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Fax | 207-783-4081
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34889
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License Number State | KY
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