Provider Demographics
NPI:1487117867
Name:GRAY, LAUREL S (MD, MS)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:S
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E RM 4A330
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-581-6465
Mailing Address - Fax:
Practice Address - Street 1:1490 N TURQUOISE DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1383
Practice Address - Country:US
Practice Address - Phone:928-774-5074
Practice Address - Fax:928-779-0884
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11921064-1205207N00000X
AZ76946207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology