Individual
LISA M GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-4930
(217) 383-4014
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
263724
NY
207VM0101X
Maternal & Fetal Medicine Physician
Primary
036154514
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2008
Last updated
06/10/2021
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