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Organization
DENNIS S. GRAY, M.D., PSC
Active
Organization
DENNIS S. GRAY, M.D., PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS S. GRAY M.D. (OWNER)
(502) 456-4100
Entity
Organization
Contact information
Practice address
1169 EASTERN PKWY, SUITE 1111, LOUISVILLE, KY 40217-1417
(502) 456-4100
(502) 459-8454
Mailing address
1169 EASTERN PKWY, SUITE 1111, LOUISVILLE, KY 40217-1417
(502) 456-4100
(502) 459-8454
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000600890
BC BS
—
01
—
3633465001
PASSPORT ADVANTAGE
KY
01
—
50021729
PASSPORT
KY
01
—
58216840
AETNA
—
05
—
7100065390
—
KY
01
—
DO3964
RR MEDICARE
KY
Enumeration date
12/11/2008
Last updated
06/10/2020
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