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NPI Code Detail

MEDICARE: DR. JERRY L GRAY MD

MEDICARE: DR. JERRY L 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
1207P00000XEmergency Medicine PhysicianG4461TX
2207P00000XEmergency Medicine PhysicianMD-12017HI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28A9550OTHERTXBLUECROSS BLUESHIELD
30000240366OTHERHIHMSA

General Provider Information

NPI Number : 1881600732
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERRY L GRAY MD
Provider Business Mailing Address
First Line : PO BOX 1266
Second Line :
City : KAILUA
State : HI
Zip : 96734-1266
Country : US
Telephone Number : 808-261-3326
Fax Number : 808-263-4604
Provider Business Practice Location Address
First Line : 1190 WAIANUENUE AVE
Second Line :
City : HILO
State : HI
Zip : 96720-2020
Country : US
Telephone Number : 808-261-3326
Fax Number : 808-263-4604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 07/08/2007

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