Individual provider Active NPI

David Alan Gray, DO

  • Pediatrics Physician
  • Lubbock, TX
National Provider Identifier
1467417253
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
J7333 Issued in TX
Practice address
4102 24TH St
Suite 506
Lubbock, TX 79410-1806
Phone
(806) 725-5500
Fax
(806) 723-7920
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X J7333 TX Primary

Addresses

Primary practice location

4102 24TH St
Suite 506
Lubbock, TX 79410-1806

Mailing address

3420 22ND Place
Lubbock, TX 79410
Phone (806) 725-5844

Other identifiers 1

IdentifierTypeStateIssuer
129012409MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110421000064 TX Practitioner - Pediatric Medicine 5597940312 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
J7333TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center Lubbock Current Accepting new patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Dec 1, 2022 Accepting new patients
Texas Tech University Health Sciences Center Lubbock Pediatrics CurrentSince Dec 1, 2022 Accepting new patients
Covenant Health System Past Accepting new patients

Locations

4102 24th St
Ste 100
Lubbock, TX 79410
Phone (806) 725-5267

3502 9th St
Ste 130
Lubbock, TX 79415
Phone (806) 743-1188

4102 24th St
Ste 506
Lubbock, TX 79410
Phone (806) 725-5500

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321833600000",
    "number": "1467417253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 22ND PLACE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79410",
            "telephone_number": "806-725-5844",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 24TH ST",
            "address_2": "SUITE 506",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101806",
            "telephone_number": "806-725-5500",
            "fax_number": "806-723-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "DAVID",
        "middle_name": "ALAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2011-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "J7333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129012409",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.