Individual
WILLIAM GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(615) 549-0721
(618) 529-0479
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 549-0721
(618) 529-0479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2016020051
MO
208M00000X
Hospitalist Physician
Primary
036150636
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE MULTISPECIALTY GROUP PTAN
IL
Enumeration date
06/23/2016
Last updated
06/04/2021
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