Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MT192846 | PA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME124154 | FL |
NPI | 1013179548 |
---|---|
Provider Name | Chancellor Folsom Gray |
First Address | Gainesville, FL 32611-2727 |
Second Address | Gainesville, FL 32607-4144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 18/08/2015 |