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General NPI Number Information
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NPI Number | 1811942014
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Entity Type | Individual
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Provider Name | ROBERT BOURDEAUX GRAY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 305 ESTILL ST
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City | BEREA
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State | KY
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Zip | 40403-1742
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Country | US
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Telephone | 859-986-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 4390 CLEARWATER WAY APT 1110
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City | LEXINGTON
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State | KY
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Zip | 40515-6359
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Country | US
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Telephone | 859-971-2279
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35942
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License Number State | KY
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