Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | P9356 | TX |
NPI | 1003134198 |
---|---|
Provider Name | Ms. Chelsea Marie Gray |
First Address | Austin, TX 78759-8862 |
Second Address | Austin, TX 78759-8862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2010 |
Last Update Date | 17/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3410326-01 | (05) | TX |
BP10036844 | PHYSICIAN IN TRAINING LICENSE (01) | TX |