Individual
DR. CAPTAIN K GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10777 NALL AVE, #315, OVERLAND PARK, KS 66211-1362
(913) 345-2622
(913) 345-2699
Mailing address
2001 BUTTERFIELD RD, STE 300, DOWNERS GROVE, IL 60515-1069
(630) 725-2700
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
0416656
KS
202K00000X
Phlebology Physician
56083
CT
202K00000X
Phlebology Physician
MD0000054563
TN
207R00000X
Internal Medicine Physician
Primary
0416656
KS
207R00000X
Internal Medicine Physician
117885
MO
207R00000X
Internal Medicine Physician
Q2669
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110132045
MEDICARE RAILROAD
KS
01
—
17344014
BLUE CROSS BLUE SHIELD OF KANSAS CITY
KS
01
—
17344024
BLUE CROSS BLUE SHIELD OF KANSAS CITY
MO
Enumeration date
03/22/2006
Last updated
03/28/2017
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