Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 606 | SC |
Y | 111NI0900X | Internist | 606 | SC |
N | 2086S0129X | Vascular Surgeon | 0606 | SC |
NPI | 1023066495 |
---|---|
Provider Name | Bruce Harvey Gray |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29615-3557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 01/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110218125 | RR MEDICARE (01) | SC |
1864198 | CIGNA (01) | SC |
4466189 | AETNA (01) | SC |
576007863071 | BCBS OF SC (01) | RI |
576007863093 | BLUE CHOICE OF SC (01) | SC |
E76446 | (02) | SC |
T00237 | (05) | SC |