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General NPI Number Information
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NPI Number | 1891890794
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Entity Type | Organization
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Legal Business Name | DR. PHILLIP H. GRAY, P.A.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 105 S FULTON ST
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City | IUKA
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State | MS
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Zip | 38852-2328
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Country | US
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Telephone | 662-423-3785
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Fax | 662-423-2849
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Provider Business Mailing Address
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Address Line | 105 S FULTON ST
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City | IUKA
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State | MS
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Zip | 38852-2328
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Country | US
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Telephone | 662-423-3785
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILLIP H GRAY
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Credential |
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Telephone | 662-423-3785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 94020
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License Number State | MS
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