Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2140 | NC |
NPI | 1316967458 |
---|---|
Provider Name | Mr. Lawrence Dennis Gray JR. |
First Address | Winston Salem, NC 27104-3849 |
Second Address | Winston Salem, NC 27104-3849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 10/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0844M | BCBS (01) | NC |
11370 | PARTNERS (01) | NC |
890844M | (05) | NC |
A4613 | MEDCOST (01) | NC |
U54604 | (02) | NC |