Provider Demographics
NPI:1568472132
Name:GRAY, PATRICK HAMPTON (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:HAMPTON
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HUNT DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334
Mailing Address - Country:US
Mailing Address - Phone:910-892-0200
Mailing Address - Fax:910-892-0204
Practice Address - Street 1:103 HUNT DRIVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334
Practice Address - Country:US
Practice Address - Phone:910-892-0200
Practice Address - Fax:910-892-0204
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936842Medicaid
NC27683OtherLICEN#
NC890260EMedicaid
NC206760FOtherINDIVIDUAL MEDICARE PTAN
NC2312457OtherGROUP MEDICARE PTAN
36842OtherGROUP BCBS
NC2312457OtherGROUP MEDICARE PTAN