Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A112324 | CA |
N | 111NI0900X | Internist | A112324 | CA |
NPI | 1003045915 |
---|---|
Provider Name | Dr. Michael Gray |
First Address | Newport Beach, CA 92659-8589 |
Second Address | Newport Beach, CA 92663-4162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2009 |
Last Update Date | 11/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01503954 | MEDICARE RAILROAD (01) | CA |