MEDICARE: MISS NADEEN W 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	207Q00000X	Family Medicine Physician	K5031	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770598831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NADEEN W GRAY MD

Provider Business Mailing Address
First Line	:	5701 W SLAUGHTER LN
Second Line	:	BLDG C
City	:	AUSTIN
State	:	TX
Zip	:	78749-6527
Country	:	US
Telephone Number	:	512-901-4479
Fax Number	:	512-901-3945

Provider Business Practice Location Address
First Line	:	5701 W SLAUGHTER LN
Second Line	:	BLDG. C
City	:	AUSTIN
State	:	TX
Zip	:	78749-6527
Country	:	US
Telephone Number	:	512-901-4031
Fax Number	:	512-334-2589

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	01/26/2022

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