MEDICARE: DR. KAREN JANE GRAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E-4840	AR
2	208000000X	Pediatrics Physician	E-4840	AR
3	207R00000X	Internal Medicine Physician	N2094	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	06070016400	OTHER	AR	QUALCHOICE

General Provider Information

NPI Number	:	1225139793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN JANE GRAY MD

Provider Business Mailing Address
First Line	:	1671 NICHOLE WOODS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4487
Country	:	US
Telephone Number	:	501-658-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1671 NICHOLE WOODS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4487
Country	:	US
Telephone Number	:	501-658-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	12/14/2009

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