MEDICARE: DR. JOSEPH W GRAY III M.D.

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	208000000X	Pediatrics Physician	35-031600	OH
2	208000000X	Pediatrics Physician	010172	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235219494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH W GRAY III M.D.

Provider Business Mailing Address
First Line	:	313 JEFFERSON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1004
Country	:	US
Telephone Number	:	419-241-4230
Fax Number	:	419-241-4231

Provider Business Practice Location Address
First Line	:	1 AURORA L GONZALEZ DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43609-2783
Country	:	US
Telephone Number	:	419-241-4230
Fax Number	:	419-241-4321

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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