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General NPI Number Information
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NPI Number | 1720090749
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Entity Type | Organization
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Legal Business Name | KEITH A GRAY MD PA
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 100 W GORE ST SUITE 303
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City | ORLANDO
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State | FL
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Zip | 32806-1044
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Country | US
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Telephone | 407-423-9920
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Fax | 407-423-0545
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Provider Business Mailing Address
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Address Line | PO BOX 568987
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City | ORLANDO
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State | FL
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Zip | 32856-8987
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Country | US
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Telephone | 407-423-9920
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Fax | 407-423-0545
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. WISTERIA Y WYCHE
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Credential |
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Telephone | 407-839-5063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME41485
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License Number State | FL
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