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General NPI Number Information
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NPI Number | 1497088199
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Entity Type | Individual
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Provider Name | ANNE GRAY LMT
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Gender | Female
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Dates
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Enumeration Date | 09/12/2009
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Last Update Date | 09/12/2009
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Provider Practice Location Address
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Address Line | 5005 NE 13TH AVE
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City | PORTLAND
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State | OR
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Zip | 97211-5079
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Country | US
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Telephone | 505-660-8066
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Fax |
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Provider Business Mailing Address
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Address Line | 7125 N GREENWICH AVE
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City | PORTLAND
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State | OR
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Zip | 97217-5445
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Country | US
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Telephone | 505-660-8066
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 14758
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License Number State | OR
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