Healthcare Provider Details

I. General information

NPI: 1639599368
Provider Name (Legal Business Name): JAMES MCDONALD GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML2008 KASOTA BUILDING, 8TH FLOOR, EMERGENCY MEDICINE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML2008
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7966
  • Fax: 513-636-7967
Mailing address:
  • Phone: 513-636-7966
  • Fax: 513-636-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61057
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35.132997
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.132997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: