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NPI Code Detail

MEDICARE: LESLIE GRAY MD

MEDICARE: LESLIE 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
1207Q00000XFamily Medicine Physician23065WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851328033
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE GRAY MD
Provider Business Mailing Address
First Line : PO BOX 8003
Second Line :
City : APPLETON
State : WI
Zip : 54912-8003
Country : US
Telephone Number : 920-996-3298
Fax Number : 920-738-5787
Provider Business Practice Location Address
First Line : 370 S MAIN ST
Second Line :
City : CLINTONVILLE
State : WI
Zip : 54929-1632
Country : US
Telephone Number : 715-823-5161
Fax Number : 715-823-1386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 02/14/2013

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