Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 1001106 | DC |
Y | 213EG0000X | General Practice | 1001106 | DC |
NPI | 1003103151 |
---|---|
Provider Name | Dr. Dominicque Blanche Gray |
First Address | Washington, DC 20019-2661 |
Second Address | Washington, DC 20019-2661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2011 |
Last Update Date | 31/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
059525000 | (05) | DC |