Individual
DR. BRADLEY WAYNE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2170 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150-7026
(530) 541-3420
Mailing address
1808 W MAIN ST, RUSSELLVILLE, AR 72801-2724
(479) 964-4178
(479) 964-5910
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-10753
AR
208M00000X
Hospitalist Physician
E-10753
AR
Other
Enumeration date
03/26/2015
Last updated
08/06/2020
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