Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD00038048 | WA |
Y | 207VX0201X | Gynecologic Oncologist | MD00038048 | WA |
NPI | 1548395486 |
---|---|
Provider Name | Heidi Joy Gray |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 21/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231182 | L&I (01) | WA |
1548395486 | (05) | WA |
I05865 | (02) |