Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 73047 | MA |
NPI | 1003882846 |
---|---|
Provider Name | Herbert E Gray III |
First Address | Falmouth, MA 02540 |
Second Address | Falmouth, MA 02540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
438893 | HPHC (01) | MA |
E58043 | (02) | |
J13653 | BCBS (01) | MA |