Provider Demographics
NPI:1043708332
Name:GEORGE WILLIAM GRAY, III, DO
Entity type:Organization
Organization Name:GEORGE WILLIAM GRAY, III, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-794-2227
Mailing Address - Street 1:2000 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2451
Mailing Address - Country:US
Mailing Address - Phone:772-794-2227
Mailing Address - Fax:772-794-9909
Practice Address - Street 1:2000 38TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2451
Practice Address - Country:US
Practice Address - Phone:772-794-2227
Practice Address - Fax:772-794-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14074261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1790183168OtherNPI