Gray, Mark W

Gray, Mark W is an individual health care provider with primary practice located at 2024 S 6Th St , Brainerd MN 56401-4529. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Gray, Mark W can be contacted via phone (218) 828-7100.

Contact Information

Primary practice address
2024 S 6Th St Brainerd MN 56401-4529
Phone: (218) 828-7100
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 25219 Minnesota

Profile Details

NPI number 1790760338
LBN Legal business name Gray, Mark W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 7th, 2005
Last updated Jan 7th, 2016 - about 8 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 1790760338 NPPES
Minnesota MEDICAID 683503100

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