Provider Demographics
NPI:1962404756
Name:GREY, CURTIS ERIC (MD)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:ERIC
Last Name:GREY
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 1:115 MEDICAL CIR
Mailing Address - Street 2:SUITE 100F
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-9004
Mailing Address - Country:US
Mailing Address - Phone:903-675-5741
Mailing Address - Fax:903-675-5677
Practice Address - Street 1:115 MEDICAL CIR
Practice Address - Street 2:SUITE 100F
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9004
Practice Address - Country:US
Practice Address - Phone:903-675-5741
Practice Address - Fax:903-675-5677
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2013-12-27
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TXL6920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162278902Medicaid
TX162278901Medicaid
TX162278902Medicaid
TXH18596Medicare UPIN