Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 18723 | NV |
N | 207N00000X | Dermatologist | A169832 | CA |
NPI | 1053706911 |
---|---|
Provider Name | Jayla Beth Gray |
First Address | Reno, NV 89509-6152 |
Second Address | Reno, NV 89509-6152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 28/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14418106 | CAQH NUMBER (01) | NV |
18723 | NV STATE LICENSE (01) | NV |
A169832 | STATE MEDICAL LICENSE (01) | CA |