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General NPI Number Information
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NPI Number | 1851905327
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Entity Type | Individual
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Provider Name | THOMAS MATTHEW GRAY RRT, RCP
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Gender | Male
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 401 BICENTENNIAL WAY STE 190
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City | SANTA ROSA
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State | CA
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Zip | 95403-2149
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Country | US
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Telephone | 707-393-3240
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Fax |
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Provider Business Mailing Address
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Address Line | 401 BICENTENNIAL WAY STE 190
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City | SANTA ROSA
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State | CA
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Zip | 95403-2149
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Country | US
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Telephone | 707-393-3240
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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 | 2279P1004X
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Taxonomy Name | Pulmonary Diagnostics Registered Respiratory Therapist
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License Number | RCP1478
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License Number State | CA
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