GRAY DERM PLLC (NPI# 1104392679) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104392679 |
Entity Type | Organization |
Organization Name | GRAY DERM PLLC |
Other Organization Name | GRAY DERM LLC |
Practice Address |
525 N Eastown Rd Ste A Lima OH 45807-2268 |
Mailing Address |
1272 Hunter Ave Columbus OH 43201-3231 |
Practice Telephone | 4199988297 |
Practice Fax Number | 4192268309 |
Mailing Telephone | 6145966789 |
Enumeration Date | 2018-10-22 |
Last Update Date | 2019-11-13 |
Authorized Official Name | BRYAN GRAY (OWNER) |
Authorized Official Telephone | 6145966789 |
Authorized Official Credential | DO |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MI | MI LICENSE | 5101021720 | 01 |
OH | OH LICENSE | 34.013501 | 01 |
Other Name | Type Code |
---|---|
Gray Derm LLC | Doing Business As Name - Organization |
Address | Telephone Number | Fax Number |
---|---|---|
1272 Hunter Ave, Columbus, OH 432013231 | 6145966789 | |
305 N Leroy St, Fenton, MI 484302729 | 8106299200 | 8106299653 |
1005 Bellefontaine Ave Ste 350, Lima, OH 458042885 | 4199988297 | 4192268309 |
Street Address |
525 N EASTOWN RD STE A |
City | LIMA |
State | OH |
Zip Code | 45807-2268 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508023896 | Lima Memorial Professional Corporation | Specialist | 525 N Eastown Rd Ste A, Lima, OH 45807-2268 | 2008-05-22 |
1013382068 | Lima Memorial Professional Corporation | Pediatrics | 525 N Eastown Rd Ste A, Lima, OH 45807-2268 | 2015-12-02 |
1831514025 | Bryan Gray | Dermatology | 525 N Eastown Rd Ste A, Lima, OH 45807-2268 | 2014-02-24 |
1871867663 | Lima Memorial Professional Corporation | Family Medicine | 525 N Eastown Rd Ste A, Lima, OH 45807-2268 | 2012-02-27 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871849828 | Ashton J. Crook | Nurse Practitioner | 3224 Jarvis Drive, Lima, OH 45807 | 2012-07-27 |
1093935140 | Lucy Marie Garland | Registered Nurse | 7070 Billymack Rd, Elida, OH 45807 | 2007-04-30 |
1629164728 | Kent Brandeberry | Family Medicine | 3224 Jarvis Dr, Lima, OH 45807 | 2006-10-05 |
1548557762 | Lima Cancer and Blood Disease Center Inc | Internal Medicine | 375 N Eastown Rd, Suite C, Lima, OH 45807 | 2011-07-08 |
1023031903 | Physicians Inc | Internal Medicine | 750 W High St, Suite 250, Lima, OH 45807 | 2006-07-25 |
1245501303 | Vickie Leeann Levan | Registered Nurse | 200 Baxter St, Elida, OH 45807-1005 | 2012-01-21 |
1255804969 | Julia M Smith | Student in an Organized Health Care Education/Training Program | 324 Baxter St, Elida, OH 45807-1007 | 2019-01-04 |
1871669317 | Steven Merritt Jones | Dentist | 409 E Kiracofe Ave, Elida, OH 45807-1031 | 2006-11-27 |
1356445084 | Todd R Bullinger | Chiropractor | 415 E Kiracofe Ave, Elida, OH 45807-1031 | 2006-09-12 |
1336590165 | Mary E Wiechart | Dentist | 409 E Kiracofe Ave, Lima, OH 45807-1031 | 2016-06-22 |
Find all providers in zip 45807 |
Taxonomy Code | 207N00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Dermatology |
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1295127371 | Alejandro Morales | Dermatology | 511 El Bucare, La Molina, Lima, LIMA 00012 | 2015-02-25 |
1992229850 | Audrey H. Jones | Dermatology | 920 W Market St Ste 320, Lima, OH 45805-2777 | 2017-08-01 |
1831514025 | Bryan Gray | Dermatology | 525 N Eastown Rd Ste A, Lima, OH 45807-2268 | 2014-02-24 |
1528256914 | Jennifer J Breedlove | Dermatology | 1005 Bellefontaine Ave Ste 350, Lima, OH 45804-2885 | 2007-10-10 |
1821011057 | Michael Riley Heaphy Sr. | Dermatology | 750 W High St, Suite 300, Lima, OH 45801-2969 | 2006-07-26 |
1730101742 | William O Light | Dermatology | 1005 Bellefontaine Ave, Ste 225, Lima, OH 45804-2896 | 2006-07-25 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023623808 | Bria Deshea Barjuca | Dermatology | 4450 Eastgate Blvd Ste 232, Cincinnati, OH 45245-1788 | 2020-09-09 |
1184263675 | Sunkiss Essentials LLC | Dermatology | 2926 State Rd Ste 369, Cuyahoga Falls, OH 44223-1244 | 2019-12-31 |
1770048894 | Teresa O'connell | Dermatology | Timeless Skin Solutions, 31 South High St, Dublin, OH 43017 | 2019-02-02 |
1144737560 | Robert Brody Md Co | Dermatology | 3461 Warrensville Center Rd Ste 101, Shaker Heights, OH 44122-5227 | 2018-01-08 |
1366893752 | Kirsten Dickinson | Dermatology | Cleveland Clinic 9500 Euclin Ave, Cleveland, OH 44195-1009 | 2016-06-27 |
1649629692 | Megan Ashley Jones-sheets | Dermatology | 75 Metro Place North, Suite 195, Dublin, OH 43017 | 2016-06-10 |
1275982746 | Samantha N Barry | Dermatology | 9403 Kenwood Rd Ste B100, Blue Ash, OH 45242-6858 | 2016-06-06 |
1720433592 | Nitin Tiwari | Dermatology | 4439 State Route 159 Ste G50, Chillicothe, OH 45601-7202 | 2016-04-29 |
1487008751 | Kiyanna Marie Williams | Dermatology | 2049 E 100th St A Building, Cleveland, OH 44195-1014 | 2016-04-22 |
1336502038 | Jacqueline Graham | Dermatology | 566 White Pond Dr Ste E, Akron, OH 44320-1116 | 2016-03-30 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.