Individual
DR. LESLIE B. GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 484-6700
Mailing address
PO BOX 5183, MERIDIAN, MS 39302-5183
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
15657
MS
2086S0129X
Vascular Surgery Physician
Primary
15657
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119529
—
MS
01
—
009809700
MEDICAID OF AL
AL
01
—
020038463
RAILROAD MEDICARE
—
Enumeration date
08/19/2005
Last updated
05/12/2020
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