Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | S01270 | MD |
N | 111NR0400X | Rehabilitation Chiropractor | S01270 | MD |
NPI | 1366528069 |
---|---|
Provider Name | Leslie M Gray III |
First Address | Ashton, MD 20861-0157 |
Second Address | Baltimore, MD 21214-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 05/09/2013 |