Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD14900 | RI |
Y | 208600000X | Surgeon | MD14900 | RI |
NPI | 1003896986 |
---|---|
Provider Name | Bradford Clayton Gray |
First Address | Rumford, RI 02916-0697 |
Second Address | Newport, RI 02840-2272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 29/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101991 | (05) | MA |
1003896986 | (05) | RI |
205717 | CONNECTICARE (01) | MA |
H18348 | (02) | |
J22582 | BLUE SHIELD (01) | MA |