Provider Demographics
NPI:1982440343
Name:GRAY, AARON RICHARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:RICHARD
Last Name:GRAY
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 1:9338 CLASSIC DR NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3190
Mailing Address - Country:US
Mailing Address - Phone:714-454-4220
Mailing Address - Fax:
Practice Address - Street 1:11582 C ST
Practice Address - Street 2:
Practice Address - City:JBLM
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-966-1991
Practice Address - Fax:253-967-2639
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant