Individual
DOUGLAS L GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11108 PARKVIEW CIRCLE DR, SUITE 5100, FORT WAYNE, IN 46845-1730
(260) 266-2800
(260) 266-2805
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01044841A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595620
ANTHEM
IN
01
—
060048219
RAILROAD MEDICARE
IN
05
—
200178590
—
IN
01
—
P00664358
RAILROAD MEDICARE
IN
Enumeration date
08/18/2005
Last updated
10/07/2022
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