Individual
DR. BENNETT G GRAY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9821 IRVINE CENTER DR, IRVINE, CA 92618-4307
(800) 741-7629
Mailing address
77 E SOUTHCREST CIR, EDWARDSVILLE, IL 62025-3147
(618) 659-0457
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036067155
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200364700A
—
KS
Enumeration date
10/03/2006
Last updated
05/13/2024
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