Provider Demographics
NPI:1104988336
Name:GRAY, CYNTHIA DEE (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:DEE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 N PIONEER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-8036
Mailing Address - Country:US
Mailing Address - Phone:360-869-2914
Mailing Address - Fax:
Practice Address - Street 1:2101 NE 139TH ST STE 285
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2326
Practice Address - Country:US
Practice Address - Phone:360-892-0096
Practice Address - Fax:360-892-1962
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE41473Medicare UPIN
WA000615545Medicare ID - Type Unspecified
OR115721Medicare ID - Type Unspecified