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General NPI Number Information
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NPI Number | 1861123929
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Entity Type | Individual
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Provider Name | TODD JAMES GRAY
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Gender | Male
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 2500 ROCKY MOUNTAIN AVE STE 100
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City | LOVELAND
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State | CO
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Zip | 80538-9004
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Country | US
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Telephone | 970-624-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 5538 MILLER CREEK RD
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City | LA PORTE CITY
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State | IA
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Zip | 50651-2140
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Country | US
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Telephone | 319-269-8709
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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 |
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License Number State |
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