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General NPI Number Information
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NPI Number | 1083770192
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Entity Type | Individual
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Provider Name | GREGORY ROBERT OBRAY PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/31/2006
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1207 EVERGREEN CT
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City | CLARKSTON
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State | WA
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Zip | 99403-2874
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Country | US
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Telephone | 509-769-2254
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Fax | 509-751-9406
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Provider Business Mailing Address
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Address Line | 320 WARNER DR
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City | LEWISTON
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State | ID
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Zip | 83501-4441
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Country | US
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Telephone | 208-743-3523
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Fax |
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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 | 00034506
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License Number State | WA
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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 | M7482
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License Number State | ID
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