Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 12731 | TX |
NPI | 1568795805 |
---|---|
Provider Name | Dr. Bill George Gray I |
First Address | Richmond, TX 77406-6818 |
Second Address | Houston, TX 77023-1497 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2009 |
Last Update Date | 17/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
090478101 | (05) | TX |