Basic Information
| Provider Information | |||||||||
| NPI: | 1013179548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | CHANCELLOR | ||||||||
| MiddleName: | FOLSOM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3450 HULL RD | ||||||||
| Address2: | PO BOX 112727 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326112727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522737001 | ||||||||
| FaxNumber: | 3522737388 | ||||||||
| Practice Location | |||||||||
| Address1: | 3450 HULL RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326074144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527737001 | ||||||||
| FaxNumber: | 3527737388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MT192846 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | ME124154 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No ID Information.