MEDICARE: PAUL ANDREW GRAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2017025344	MO

General Provider Information

NPI Number	:	1144163916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANDREW GRAY

Provider Business Mailing Address
First Line	:	1908 JACKSON ST
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3183
Country	:	US
Telephone Number	:	402-570-5539
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 VANDIVER DR STE 100
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3754
Country	:	US
Telephone Number	:	402-570-5539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ PAUL ANDREW GRAY ” Practice Location

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