Individual
JERMAINE E GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Mailing address
500 UNIVERSITY DRIVE, HERSHEY, PA 17033-2360
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
MD473875
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04358321
—
MS
01
—
08103071
UP MEDICAID GROUP PROV#
MS
01
—
160000807
MEDICARE PROV #
MS
01
—
512G700003
UP MEDICARE GRP PROV#
MS
01
—
512I160025
MEDICARE PTAN#
MS
Enumeration date
10/23/2006
Last updated
09/01/2021
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