Individual
PATRICK WALLACE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 FAIRVIEW AVE, SUITE 17, PONCA CITY, OK 74601-1910
(580) 762-3696
(580) 765-0675
Mailing address
400 FAIRVIEW AVE, SUITE 17, PONCA CITY, OK 74601-1910
(580) 762-3696
(580) 765-0675
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15395
OK
Other
Enumeration date
07/13/2005
Last updated
08/28/2012
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