MEDICARE: PETER F GRAY MD PA

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	E7609	TX

General Provider Information

NPI Number	:	1679578082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER F GRAY MD PA

Provider Business Mailing Address
First Line	:	PO BOX 1078
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75403-1078
Country	:	US
Telephone Number	:	903-453-2901
Fax Number	:	903-453-2903

Provider Business Practice Location Address
First Line	:	4101 WESLEY ST
Second Line	:	STE D
City	:	GREENVILLE
State	:	TX
Zip	:	75401-5635
Country	:	US
Telephone Number	:	903-453-2901
Fax Number	:	903-453-2903

Authorized Official
Title or Position	:	OWNER
Name	:	PETER F GRAY
Credential	:	M.D.
Telephone Number	:	903-453-2901

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	10/19/2009

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