Provider Demographics
NPI:1033731344
Name:GRAY, BARTU C
Entity type:Individual
Prefix:MR
First Name:BARTU
Middle Name:C
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 W THUNDERBIRD RD APT 2174
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4859
Mailing Address - Country:US
Mailing Address - Phone:480-799-9484
Mailing Address - Fax:
Practice Address - Street 1:5205 W THUNDERBIRD RD APT 2174
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4859
Practice Address - Country:US
Practice Address - Phone:480-799-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000Other0000000000