MEDICARE: DR. DENNIS S 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	21462	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080135036	OTHER	KY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	50021730	OTHER	KY	PASSPORT
3	6896823	OTHER	KY	CIGNA
4	3633466000	OTHER	KY	PASSPORT ADVANTAGE
5	4380607	OTHER	KY	AETNA
6	000000600891	OTHER		BC BS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942202288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS S GRAY M.D.

Provider Business Mailing Address
First Line	:	1169 EASTERN PKWY
Second Line	:	STE 1111
City	:	LOUISVILLE
State	:	KY
Zip	:	40217-1462
Country	:	US
Telephone Number	:	502-456-4100
Fax Number	:	502-459-8454

Provider Business Practice Location Address
First Line	:	1169 EASTERN PKWY
Second Line	:	STE 1111
City	:	LOUISVILLE
State	:	KY
Zip	:	40217-1462
Country	:	US
Telephone Number	:	502-456-4100
Fax Number	:	502-459-8454

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	06/10/2020

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Directions to “ DR. DENNIS S GRAY M.D.” Practice Location

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