Provider Demographics
NPI:1699966416
Name:GREY, LAURENCE ALLYN KEITH (NMD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:ALLYN KEITH
Last Name:GREY
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 E BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5414
Mailing Address - Country:US
Mailing Address - Phone:602-999-8118
Mailing Address - Fax:905-721-9899
Practice Address - Street 1:1487 E BOSTON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5414
Practice Address - Country:US
Practice Address - Phone:602-999-8118
Practice Address - Fax:905-721-9899
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ99-558175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath