Individual
SUSAN J. GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1345 SMIZER MILL RD STE 1100, FENTON, MO 63026-7305
(636) 496-5023
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2016009600
MO
207Q00000X
Family Medicine Physician
34741
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
347413
—
SC
01
—
P01593526
RAILROAD MEDICARE
SC
Enumeration date
04/26/2012
Last updated
03/19/2025
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