MEDICARE: KRISTEN DAVID GRAY M.D.

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	ME85090	FL
2	207Q00000X	Family Medicine Physician	80188	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	K9529	OTHER	FL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	593339550	OTHER	FL	TAX IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	592696120	OTHER	FL	TAX IDENIFICATION
5	593339550	OTHER	FL	WINTER PARK FAMILY HEALTH CENTER, INC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861481517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN DAVID GRAY M.D.

Provider Business Mailing Address
First Line	:	1595 N WILLIAMSON BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-7214
Country	:	US
Telephone Number	:	386-259-6026
Fax Number	:	386-615-6665

Provider Business Practice Location Address
First Line	:	290 CLYDE MORRIS BLVD STE C2
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8204
Country	:	US
Telephone Number	:	386-259-6026
Fax Number	:

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	03/14/2025

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Directions to “ KRISTEN DAVID GRAY M.D.” Practice Location

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