Basic Information
Provider Information
NPI: 1285864405
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRAY
FirstName: NATHAN
MiddleName: ALEXANDER
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3024 NEW BERN AVE
Address2:  
City: RALEIGH
State: NC
PostalCode: 276101247
CountryCode: US
TelephoneNumber: 9193507270
FaxNumber:  
Practice Location
Address1: 2301 ERWIN RD
Address2:  
City: DURHAM
State: NC
PostalCode: 277054699
CountryCode: US
TelephoneNumber: 9196848111
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/22/2009
LastUpdateDate: 07/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X2012-01288NCY Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X2012-01288NCN Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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