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General NPI Number Information
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NPI Number | 1083231369
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Entity Type | Individual
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Provider Name | TYLER DAVID GRAY PA
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Gender | Male
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 5 CARE LN
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-8623
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Country | US
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Telephone | 518-489-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 121 EVERETT RD STE 100
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City | ALBANY
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State | NY
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Zip | 12205-1447
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Country | US
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Telephone | 518-453-9088
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Fax | 518-689-3817
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 025133
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License Number State | NY
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