Individual
CHARLESTON GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
516 E. NIZHONI BLVD, GALLUP INDIAN MEDICAL CENTER, GALLUP, NM 87301
(505) 722-1000
Mailing address
516 E. NIZHONI BLVD, GALLUP INDIAN MEDICAL CENTER, GALLUP, NM 87301
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
771013
CA
Other
Enumeration date
04/27/2017
Last updated
04/27/2017
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