| Keith a Gray MD PA | |
|
100 W Gore St Suite 303 Orlando FL 32806-1044 | |
| (407) 423-9920 | |
| (407) 423-0545 |
| Full Name | Keith a Gray MD PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 100 W Gore St, Orlando, Florida |
| Authorized Official Name and Position | Wisteria Y Wyche (OFFICE MANAGER) |
| Authorized Official Contact | 4078395063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keith a Gray MD PA Po Box 568987 Orlando FL 32856-8987 Ph: (407) 423-9920 | Keith a Gray MD PA 100 W Gore St Suite 303 Orlando FL 32806-1044 Ph: (407) 423-9920 |
| NPI Number | 1720090749 |
|---|---|
| Provider Enumeration Date | 08/12/2006 |
| Last Update Date | 04/20/2011 |
| Medicare PECOS PAC ID | 2961501986 |
|---|---|
| Medicare Enrollment ID | O20070615000366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720090749 | NPI | - | NPPES |
| 255117900 | Medicaid | FL | |
| 47582 | Other | FL | BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME41485 (Florida) | Primary |
| Provider Name | Keith a Gray |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033195177 PECOS PAC ID: 3779514328 Enrollment ID: I20050824000305 |
| Provider Name | Silviya Geneva Dragieva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205350113 PECOS PAC ID: 7214281351 Enrollment ID: I20181108001548 |
| Provider Name | Thuy T Kolomiyets |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578156238 PECOS PAC ID: 5294133369 Enrollment ID: I20211005001480 |
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