| Dennis S. Gray, M.d., Psc | |
|
1169 Eastern Pkwy Suite 1111 Louisville KY 40217-1417 | |
| (502) 456-4100 | |
| (502) 459-8454 |
| Full Name | Dennis S. Gray, M.d., Psc |
|---|---|
| Speciality | Family Medicine |
| Location | 1169 Eastern Pkwy, Louisville, Kentucky |
| Authorized Official Name and Position | Dennis S. Gray (OWNER) |
| Authorized Official Contact | 5024564100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dennis S. Gray, M.d., Psc 1169 Eastern Pkwy Suite 1111 Louisville KY 40217-1417 Ph: (502) 456-4100 | Dennis S. Gray, M.d., Psc 1169 Eastern Pkwy Suite 1111 Louisville KY 40217-1417 Ph: (502) 456-4100 |
| NPI Number | 1194960682 |
|---|---|
| Provider Enumeration Date | 12/11/2008 |
| Last Update Date | 06/10/2020 |
| Medicare PECOS PAC ID | 6305900424 |
|---|---|
| Medicare Enrollment ID | O20090204000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194960682 | NPI | - | NPPES |
| 000000600890 | Other | BC BS | |
| 58216840 | Other | AETNA | |
| 3633465001 | Other | KY | PASSPORT ADVANTAGE |
| DO3964 | Other | KY | RR MEDICARE |
| 50021729 | Other | KY | PASSPORT |
| 7100065390 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Dennis S Gray |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942202288 PECOS PAC ID: 9436247947 Enrollment ID: I20090204000007 |
| Provider Name | Toni L Raybon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013241843 PECOS PAC ID: 8527105758 Enrollment ID: I20091021000228 |
| Provider Name | Theresa Ann Goodman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316379324 PECOS PAC ID: 2264656149 Enrollment ID: I20140616001449 |
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