MEDICARE: DR. JEFFREY JAMES GRAY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	671	OR

General Provider Information

NPI Number	:	1649341827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY JAMES GRAY PH.D.

Provider Business Mailing Address
First Line	:	2254 NW WEST HILLS AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-1047
Country	:	US
Telephone Number	:	541-382-6022
Fax Number	:	541-382-8070

Provider Business Practice Location Address
First Line	:	2254 NW WEST HILLS AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-1047
Country	:	US
Telephone Number	:	541-382-6022
Fax Number	:	541-382-8070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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