Doctor Name: | TYLER GRAY |
NPI Number: | 1497020846 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 3569 Round Barn Cir Ste 200 Santa Rosa, CA - 954035781 |
Business Phone Number: | 7075838800 |
Business Fax Number: | 7075838808 |
Mailing Address: | 1501 Division St, Larry Young Div Hlth BALTIMORE |
State: | MD |
Postal Code: | 212173121 |
Phone Number: | 4103838300 |
Fax Number: | |
NPI Enumeration Date: | 03/19/2012 |
NPI Last Update Date: | 12/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |