Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 2015-00395 | NC |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD60930373 | WA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | ME117908 | FL |
NPI | 1013947142 |
---|---|
Provider Name | Dr. Angela Lorraine Gray |
First Address | Tacoma, WA 98405-4930 |
Second Address | Tacoma, WA 98405-4930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010203600 | (05) | FL |
02565180 | (05) | NY |
140226CK | PREFERRED CARE (01) | NY |
14T9X | BCBS (01) | FL |
2137369 | (05) | WA |
7380613 | AETNA (01) | NY |
HQ437Z | (02) | FL |
I14109 | (02) | NY |
P010232675 | BLUE CHOICE (01) | NY |
P020232675 | BLUE SHIELD OF ROCHESTER (01) | NY |