Provider Demographics
NPI:1073873949
Name:GRAY, MICHAEL L (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:GRAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 NW 11TH PLACE
Mailing Address - Street 2:STE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4215
Mailing Address - Country:US
Mailing Address - Phone:352-331-9729
Mailing Address - Fax:352-331-0136
Practice Address - Street 1:6716 NW 11TH PLACE
Practice Address - Street 2:STE 200
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4215
Practice Address - Country:US
Practice Address - Phone:352-331-9729
Practice Address - Fax:352-331-0136
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106653363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01080536OtherRAILROAD MEDICARE
FLY0C4POtherBCBS FL
FL006304500Medicaid
FLP01080540OtherRAILROAD MEDICARE
FLY0C4POtherBCBS FL
FLGH154YMedicare PIN