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NPI Code Detail

MEDICARE: BLANCA LUCIA GRAY MD

MEDICARE: BLANCA LUCIA 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
1207R00000XInternal Medicine PhysicianJ4166TX

General Provider Information

NPI Number : 1811905789
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLANCA LUCIA GRAY MD
Provider Business Mailing Address
First Line : 4302 AYERS ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-5318
Country : US
Telephone Number : 361-356-4006
Fax Number :
Provider Business Practice Location Address
First Line : 4302 AYERS ST
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-5318
Country : US
Telephone Number : 361-356-4006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/25/2022

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