Provider Demographics
NPI:1154429223
Name:GRAY, DOUGLAS D (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 S. KOMAS DRIVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108
Mailing Address - Country:US
Mailing Address - Phone:801-585-1212
Mailing Address - Fax:
Practice Address - Street 1:650 KOMAS DR
Practice Address - Street 2:#208
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1215
Practice Address - Country:US
Practice Address - Phone:801-585-1212
Practice Address - Fax:801-585-9096
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT17474712052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry