| Entity Name: | GEORGE WILLIAM GRAY, III, DO, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Mar 2022 (3 years ago) |
| Document Number: | P22000027547 |
| FEI/EIN Number | 82-2195911 |
| Address: | 2000 38TH AVENUE, VERO BEACH, FL, 32960, US |
| Mail Address: | 2000 38TH AVENUE, VERO BEACH, FL, 32960, US |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043708332 | 2018-04-23 | 2018-04-23 | 2000 38TH AVE, VERO BEACH, FL, 329602451, US | 2000 38TH AVE, VERO BEACH, FL, 329602451, US | |||||||||||||||||||||||||
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| Phone | +1 772-794-2227 |
| Fax | 7727949909 |
Authorized person
| Name | RACHEL GLENTON |
| Role | OFFICE MANAGER |
| Phone | 7727942227 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | OS14074 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1790183168 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GRAY GEORGE III | Agent | 2000 38TH AVENUE, VERO BEACH, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| GRAY GEORGE III | President | 2000 38TH AVENUE, VERO BEACH, FL, 32960 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-01-25 |
| Domestic Profit | 2022-03-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
