# DENNIS S. GRAY, M.D., PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194960682
- **Authorized official:** DR. DENNIS S. GRAY M.D. (OWNER)
- **Authorized official phone:** (502) 456-4100

## Contact information

- **Practice address:** 1169 EASTERN PKWY, SUITE 1111, LOUISVILLE, KY 40217-1417
- **Practice address phone:** (502) 456-4100
- **Practice address fax:** (502) 459-8454
- **Mailing address:** 1169 EASTERN PKWY, SUITE 1111, LOUISVILLE, KY 40217-1417
- **Mailing address phone:** (502) 456-4100
- **Mailing address fax:** (502) 459-8454

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 12/11/2008
- **Last updated:** 06/10/2020

## 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 |