Provider Demographics
NPI:1154323608
Name:GRAY, ROGER SLOAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:SLOAN
Last Name:GRAY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1110 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6133
Mailing Address - Country:US
Mailing Address - Phone:715-834-8471
Mailing Address - Fax:715-834-0373
Practice Address - Street 1:2820 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8573
Practice Address - Country:US
Practice Address - Phone:745-234-8444
Practice Address - Fax:715-234-0041
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI30897020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31602400Medicaid
F26672Medicare UPIN
WI00105015Medicare ID - Type Unspecified