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General NPI Number Information
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NPI Number | 1841375284
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Entity Type | Individual
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Provider Name | GERALD GENE GRAY DO
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HWY 64 WEST
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City | OAKLAND CITY
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State | IN
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Zip | 47660-0037
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Country | US
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Telephone | 812-677-1244
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Fax | 812-749-3765
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | OAKLAND CITY
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State | IN
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Zip | 47660-0037
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Country | US
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Telephone | 812-677-1244
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Fax | 812-749-3765
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 02000256A
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License Number State | IN
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