Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 122450 | FL |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 65022 | MN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 7910 | SD |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD-427277 | PA |
NPI | 1447332895 |
---|---|
Provider Name | Dr. Scharazard Lee Gray |
First Address | International Falls, MN 56649-8724 |
Second Address | International Falls, MN 56649-2421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 02/02/2022 |