Healthcare Provider Details

I. General information

NPI: 1053614511
Provider Name (Legal Business Name): JAMES DOUGLASS GRAY R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 FRANKLIN AVE
CINTI OH
45237
US

IV. Provider business mailing address

1530 FRANKLIN AVE
CINTI OH
45237
US

V. Phone/Fax

Practice location:
  • Phone: 513-242-2164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.196388
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: