MEDICARE: DR. WILLIAM TODD GRAY D.O.

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	L0810	TX
2	207RC0000X	Cardiovascular Disease Physician	L0810	TX
3	207RI0011X	Interventional Cardiology Physician	L0180	TX
4	207UN0901X	Nuclear Cardiology Physician	L0810	TX
5	207RI0011X	Interventional Cardiology Physician	L0810	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01095620	OTHER	TX	MEDICARE RR

General Provider Information

NPI Number	:	1467407197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM TODD GRAY D.O.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3341 UNICORN LAKE BLVD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0102
Country	:	US
Telephone Number	:	469-814-4475
Fax Number	:	469-814-4480

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	12/11/2023

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Directions to “ DR. WILLIAM TODD GRAY D.O.” Practice Location

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