Provider Demographics
NPI:1194960682
Name:DENNIS S. GRAY, M.D., PSC
Entity type:Organization
Organization Name:DENNIS S. GRAY, M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-456-4100
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE 1111
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-456-4100
Mailing Address - Fax:502-459-8454
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:SUITE 1111
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-456-4100
Practice Address - Fax:502-459-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000600890OtherBC BS
58216840OtherAETNA
KY3633465001OtherPASSPORT ADVANTAGE
KYDO3964OtherRR MEDICARE
KY50021729OtherPASSPORT
KY7100065390Medicaid
KY00880Medicare PIN