Healthcare Provider Details

I. General information

NPI: 1285989988
Provider Name (Legal Business Name): JOEL MICHAEL GREY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 ANDERSON RD STE 10
DAVIS CA
95616-3505
US

IV. Provider business mailing address

815 GARRATT LANE GROUND FLOOR FLAT
LONDON ENGLAND
SW17 0PF
GB

V. Phone/Fax

Practice location:
  • Phone: 530-758-1122
  • Fax:
Mailing address:
  • Phone: 011447804619318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: