Provider Demographics
NPI:1548264302
Name:NUNLEY, MICHAEL GRAY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GRAY
Last Name:NUNLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1220 LEE ST E STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1864
Mailing Address - Country:US
Mailing Address - Phone:304-343-4124
Mailing Address - Fax:304-343-4167
Practice Address - Street 1:1220 LEE ST E STE 203
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1864
Practice Address - Country:US
Practice Address - Phone:304-343-4124
Practice Address - Fax:304-343-4167
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV16744207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095491000Medicaid
WV0095491000Medicaid
WV1292840001Medicare NSC