1134154941 NPI number — DR. DEVIN LYNN GRAY MD

Table of content: DR. DEVIN LYNN GRAY MD (NPI 1134154941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134154941 NPI number — DR. DEVIN LYNN GRAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
DEVIN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAY
Provider Other First Name:
DEVIN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD F.A.C.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1134154941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2558 S RIATA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85295-5948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-892-2456
Provider Business Mailing Address Fax Number:
480-892-2458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4135 S POWER RD
Provider Second Line Business Practice Location Address:
STE 117
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85212-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-892-2456
Provider Business Practice Location Address Fax Number:
480-892-2458
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  22813 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00091989 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z0654 . This is a "HEAL;THNET AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 339110 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: F11833 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0891430 . This is a "BCBS AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".