Provider Demographics
NPI:1023629482
Name:GRAY, CARLOS ROSALREIO (MRI TECHNOLOGIST)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ROSALREIO
Last Name:GRAY
Suffix:
Gender:M
Credentials:MRI TECHNOLOGIST
Other - Prefix:
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Mailing Address - Street 1:1502 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3882
Mailing Address - Country:US
Mailing Address - Phone:190-133-6286
Mailing Address - Fax:
Practice Address - Street 1:1502 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3882
Practice Address - Country:US
Practice Address - Phone:901-336-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3208322471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty