Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 15784 | SC |
NPI | 1023087962 |
---|---|
Provider Name | Timothy K Gray |
First Address | North Charleston, SC 29406-9193 |
Second Address | North Charleston, SC 29406-9193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 18/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C84155 | (02) |