Provider Demographics
NPI:1962119735
Name:JOHN M. GRAY, MD, PLLC
Entity type:Organization
Organization Name:JOHN M. GRAY, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-484-0053
Mailing Address - Street 1:7713 CENTER BLVD SE STE 160
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-6309
Mailing Address - Country:US
Mailing Address - Phone:425-292-3347
Mailing Address - Fax:425-738-3020
Practice Address - Street 1:7713 CENTER BLVD SE STE 160
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-6309
Practice Address - Country:US
Practice Address - Phone:425-292-3347
Practice Address - Fax:425-738-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty