Individual
ANDREA B GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
823 PARK EAST BLVD STE H, LAFAYETTE, IN 47905-0811
(765) 448-6226
(765) 448-9416
Mailing address
823 PARK EAST BLVD STE H, LAFAYETTE, IN 47905-0811
(765) 448-6226
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23002183A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000179545
ANTHEM PROVIDER NUMBER
IN
05
—
200180390
—
IN
01
—
9397785
PHCS PID NUMBER
IN
05
—
HA57500064
—
IN
Enumeration date
03/23/2006
Last updated
06/02/2020
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