Organization
FORT WAYNE CARDIOVASCULAR SURGEON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS L GRAY MD (PRESIDENT/PARTNER)
(260) 483-6448
Entity
Organization
Contact information
Practice address
11123 PARKVIEW PLAZA DR, SUITE 202, FORT WAYNE, IN 46845-1707
(260) 483-6448
(260) 373-4167
Mailing address
1818 CAREW STREEET, SUITE 250, FORT WAYNE, IN 46805
(260) 483-6448
(260) 373-4167
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
50000046A
IN
Other
Enumeration date
07/10/2006
Last updated
08/22/2020
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