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General NPI Number Information
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NPI Number | 1861481517
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Entity Type | Individual
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Provider Name | KRISTEN DAVID GRAY M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 290 CLYDE MORRIS BLVD STE C2
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8204
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Country | US
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Telephone | 386-259-6026
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Fax |
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Provider Business Mailing Address
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Address Line | 1595 N WILLIAMSON BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7214
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Country | US
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Telephone | 386-259-6026
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Fax | 386-615-6665
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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 | ME85090
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 80188
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License Number State | CT
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