Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 35320 | TN |
NPI | 1235237843 |
---|---|
Provider Name | Keith D. Gray |
First Address | Nashville, TN 37244-0251 |
Second Address | Knoxville, TN 37920-1512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 12/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3864934 | (05) | TN |
H51143 | (02) |