Provider Demographics
NPI:1285989988
Name:GREY, JOEL MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:MICHAEL
Last Name:GREY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GARRATT LANE
Mailing Address - Street 2:GROUND FLOOR FLAT
Mailing Address - City:LONDON
Mailing Address - State:ENGLAND
Mailing Address - Zip Code:SW17 0PF
Mailing Address - Country:GB
Mailing Address - Phone:01144780-461-9318
Mailing Address - Fax:
Practice Address - Street 1:635 ANDERSON RD STE 10
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3505
Practice Address - Country:US
Practice Address - Phone:530-758-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant