MEDICARE: ROBERT W GRAY DPH

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	183500000X	Pharmacist	005858	TN

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	4424595	OTHER	TN	NCPDP
3	1454364	OTHER	TN	TN MEDICAL ASSISTANCE

General Provider Information

NPI Number	:	1659411494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT W GRAY DPH

Provider Business Mailing Address
First Line	:	45 S MECHANIC ST
Second Line	:	P.O. BOX 174
City	:	LYNCHBURG
State	:	TN
Zip	:	37352-8353
Country	:	US
Telephone Number	:	931-759-7329
Fax Number	:	931-759-4604

Provider Business Practice Location Address
First Line	:	45 S MECHANIC ST
Second Line	:
City	:	LYNCHBURG
State	:	TN
Zip	:	37352-8353
Country	:	US
Telephone Number	:	931-759-7329
Fax Number	:	931-759-4604

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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