Healthcare Provider Details

I. General information

NPI: 1609701671
Provider Name (Legal Business Name): GARY GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 UNIVERSITY AVENUE 7C118
EDMONTON ALBERTA
T6G1Z1
CA

IV. Provider business mailing address

97-52319 RANGE ROAD 231
SHERWOOD PARK ALBERTA
T8B1A8
CA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD00036341
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: