Basic Information
| Provider Information | |||||||||
| NPI: | 1518187186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | STEPHEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1153 BERGEN PKWY # M218 | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804399501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208410798 | ||||||||
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| Practice Location | |||||||||
| Address1: | 255 UNION BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039869610 | ||||||||
| FaxNumber: | 3036839392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 11/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 27554 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 2083X0100X | 27554 | CO | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.