Organization
NORTHERN MICHIGAN DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ROGER GRAY D.O. (PHYSICIAN/CORPORATE PRESIDENT)
(231) 627-3800
Entity
Organization
Contact information
Practice address
125 N MAIN ST, CHEBOYGAN, MI 49721-1637
(231) 627-3800
(231) 627-2482
Mailing address
125 N MAIN ST, CHEBOYGAN, MI 49721-1637
(231) 627-3800
(231) 627-2482
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
WG008271
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0751600054
BCBSM
—
05
—
3055165
—
MI
Enumeration date
09/21/2007
Last updated
10/05/2010
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