Healthcare Provider Details

I. General information

NPI: 1407863038
Provider Name (Legal Business Name): JOHN M GRAY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S MAIN ST
SALINAS CA
93901-2260
US

IV. Provider business mailing address

PO BOX 2300
SALINAS CA
93902-2300
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-7777
  • Fax: 831-422-0136
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: