MEDICARE: MR. JOHN TOBIAS GRAY PA-C

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	363AS0400X	Surgical Physician Assistant	PA 3649	FL

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	:	1992729685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN TOBIAS GRAY PA-C

Provider Business Mailing Address
First Line	:	1995 E OAKLAND PARK BLVD STE 250
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1149
Country	:	US
Telephone Number	:	954-533-2350
Fax Number	:	954-337-2733

Provider Business Practice Location Address
First Line	:	1995 E OAKLAND PARK BLVD
Second Line	:	SUITE 250
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1147
Country	:	US
Telephone Number	:	954-791-6146
Fax Number	:	954-337-2733

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/30/2019

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