Provider Demographics
NPI:1447278916
Name:GRAY, DIANA L (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-8181
Mailing Address - Fax:314-747-1429
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV OBGYN MFM AND US, STE 710
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-454-8181
Practice Address - Fax:314-747-1429
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR6E29207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202119004Medicaid
ILENROLLEDMedicaid
IL$$$$$$$$$Medicaid
MO006010217Medicaid