Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G8145 | TX |
NPI | 1003841909 |
---|---|
Provider Name | Dr. Barbara Lynne Gray |
First Address | Austin, TX 78750-1867 |
Second Address | Austin, TX 78750-1867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 16/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
376447ZKPT | PTAN (01) | TX |
B87966 | (02) | TX |