1740461177 NPI number — DAVID J GRAY PC

Table of content: (NPI 1740461177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740461177 NPI number — DAVID J GRAY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID J GRAY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALABAMA AESTHETIC SURGERY ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1740461177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 ADAMS ST SE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-265-7957
Provider Business Mailing Address Fax Number:
256-265-7965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 ADAMS ST SE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-265-7957
Provider Business Practice Location Address Fax Number:
256-265-7965
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
256-265-7957

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  25672 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51519686 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51519686 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com