Gray, Kristen David

Gray, Kristen David is an individual health care provider with primary practice located at 290 Clyde Morris Blvd Ste C2 , Ormond Beach FL 32174-8204. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Gray, Kristen David can be contacted via phone (386) 259-6026.

Contact Information

Primary practice address
290 Clyde Morris Blvd Ste C2 Ormond Beach FL 32174-8204
Phone: (386) 259-6026
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME85090 Florida

Profile Details

NPI number 1861481517
LBN Legal business name Gray, Kristen David
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2005
Last updated Nov 8th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861481517 NPPES
Florida Other 593339550 TAX IDENTIFICATION NUMBER
Florida Other 592696120 TAX IDENTIFICATION NUMBER
Florida MEDICAID 264274300 TAX IDENTIFICATION NUMBER
Florida Other K9529 TAX IDENTIFICATION NUMBER
Florida Other 593339550 TAX IDENTIFICATION NUMBER

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