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
—
—
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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