Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DO3412 | TN |
NPI | 1003293028 |
---|---|
Provider Name | Dr. Brian Robert Gray |
First Address | Murfreesboro, TN 37127-6382 |
Second Address | Murfreesboro, TN 37127-6382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2015 |
Last Update Date | 25/06/2020 |