Individual
BRIAN WALLACE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
705 RILEY HOSPITAL DR RM 2500, INDIANAPOLIS, IN 46202-5109
(317) 439-1949
(317) 274-4603
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01074108A
IN
2086S0120X
Pediatric Surgery Physician
Primary
01074108A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201238800
—
IN
Enumeration date
05/18/2007
Last updated
10/14/2021
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