Basic Information
| Provider Information | |||||||||
| NPI: | 1902814874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | CABELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 919 HIDDEN RDG | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750383813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692822711 | ||||||||
| FaxNumber: | 4692820996 | ||||||||
| Practice Location | |||||||||
| Address1: | 2510 E MAIN ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ALICE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783324187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3616618390 | ||||||||
| FaxNumber: | 3616618395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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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 | 207R00000X | J4167 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 85329301 | 05 | TX | MEDICAID | 044504103 | 05 | TX | MEDICAID | P00420344 | 01 | TX | RAILROAD MEDICARE | OTHER | 8X9650 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |