1588666317 NPI number — WILLIAM J GRAY MD

Table of content: WILLIAM J GRAY MD (NPI 1588666317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588666317 NPI number — WILLIAM J GRAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
WILLIAM
Provider Middle Name:
J
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588666317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 W COOMER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORENCI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49256-1352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-458-6109
Provider Business Mailing Address Fax Number:
517-458-6131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 W COOMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORENCI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49256-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-458-6109
Provider Business Practice Location Address Fax Number:
517-458-6131
Provider Enumeration Date:
08/11/2005

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: 208000000X , with the licence number:  4301065541 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4310165541 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2409558 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4999987 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04-07759 . This is a "UHC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7917019 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 04286 . This is a "PHC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 142870 . This is a "GLHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00025330 . This is a "RRMC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 23267 . This is a "HPM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4494722 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104607522 . This is a "BCBS MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 131372 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000358054 . This is a "ANTHEM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 131372 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 161036 . This is a "GLHP" identifier . This identifiers is of the category "OTHER".




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