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General NPI Number Information
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NPI Number | 1679782411
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Entity Type | Organization
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Legal Business Name | SCOTT K GRAY DPM PA
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 8604 DOLLARWAY RD
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City | WHITE HALL
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State | AR
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Zip | 71602-2814
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Country | US
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Telephone | 870-536-3669
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Fax | 870-536-0149
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Provider Business Mailing Address
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Address Line | 8604 DOLLARWAY RD
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City | WHITE HALL
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State | AR
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Zip | 71602-2814
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Country | US
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Telephone | 870-536-3669
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Fax | 870-536-0149
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Authorized Official
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Title or Position | PRESIDENT SECRETARY
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Name | DR. SCOTT K GRAY
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Credential | DPM
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Telephone | 870-536-3669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 197
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License Number State | AR
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