Provider Demographics
NPI:1144342635
Name:BLANCA LUCIA GRAY MD PA
Entity type:Organization
Organization Name:BLANCA LUCIA GRAY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-949-8080
Mailing Address - Street 1:14646 COMPASS ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6231
Mailing Address - Country:US
Mailing Address - Phone:361-949-8080
Mailing Address - Fax:361-949-7988
Practice Address - Street 1:14646 COMPASS ST
Practice Address - Street 2:SUITE 8
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6231
Practice Address - Country:US
Practice Address - Phone:361-949-8080
Practice Address - Fax:361-949-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty