MEDICARE: KIMBERLY GRAY-WHITE 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	291U00000X	Clinical Medical Laboratory	ME110366	FL

General Provider Information

NPI Number	:	1851795223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY GRAY-WHITE MD PA

Provider Business Mailing Address
First Line	:	508 W DR. MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33603
Country	:	US
Telephone Number	:	954-229-1924
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33603-3415
Country	:	US
Telephone Number	:	954-229-1924
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	KIMBERLY M GRAY-WHITE
Credential	:	MD
Telephone Number	:	813-229-1924

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	10/14/2014

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