Individual
DAVID R GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 S CREASY LN, SUITE A, LAFAYETTE, IN 47905-4960
(765) 449-2732
(765) 449-1196
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01041342A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000110554
ANTHEM PROVIDER
IN
05
—
200165100
—
IN
Enumeration date
03/15/2006
Last updated
04/02/2009
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