1376647362 NPI number — MR. THURMAN ADONIS GRAY

Table of content: MR. THURMAN ADONIS GRAY (NPI 1376647362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376647362 NPI number — MR. THURMAN ADONIS GRAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
THURMAN
Provider Middle Name:
ADONIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1376647362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 STURGEON COURT
Provider Second Line Business Mailing Address:
STE 121
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-375-8822
Provider Business Mailing Address Fax Number:
817-375-8883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 STURGEON COURT
Provider Second Line Business Practice Location Address:
STE 121
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-375-8822
Provider Business Practice Location Address Fax Number:
817-375-8883
Provider Enumeration Date:
09/11/2006

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: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2291873 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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