Basic Information
| Provider Information | |||||||||
| NPI: | 1437295698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11700 W 2ND PL | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035952727 | ||||||||
| FaxNumber: | 3036292228 | ||||||||
| Practice Location | |||||||||
| Address1: | 11700 W 2ND PL | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035952727 | ||||||||
| FaxNumber: | 3036292228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 02/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 254100 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 53631 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 45275343 | 05 | CO | MEDICAID |