MEDICARE: MICHAEL E 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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	M-8013	ID

General Provider Information

NPI Number	:	1932164126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E GRAY MD

Provider Business Mailing Address
First Line	:	PO BOX 553
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83303-0553
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 POLE LINE RD W
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5810
Country	:	US
Telephone Number	:	208-814-0362
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	11/23/2011

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