Healthcare Provider Details

I. General information

NPI: 1205211497
Provider Name (Legal Business Name): JAY PAUL GRAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 CORPORATE CENTRE DR STE 150
LAWRENCE KS
66047-1002
US

IV. Provider business mailing address

9300 E 29TH ST N BLDG 300
WICHITA KS
67226-2182
US

V. Phone/Fax

Practice location:
  • Phone: 785-730-8770
  • Fax: 785-730-8780
Mailing address:
  • Phone: 316-612-1833
  • Fax: 316-612-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01819
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: