Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | H0396 | TX |
NPI | 1043321987 |
---|---|
Provider Name | Brent Morgan Gray |
First Address | Bryan, TX 77802-2547 |
Second Address | Bryan, TX 77802-2547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D43992 | (02) |