Healthcare Provider Details

I. General information

NPI: 1831712272
Provider Name (Legal Business Name): RONALD G GRAY II APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

108 BERNICE DR
BEAR DE
19701-2000
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5560
  • Fax:
Mailing address:
  • Phone: 302-593-8689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number60130
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: