Provider Demographics
NPI:1225503733
Name:SMITH, GRAY H (NP)
Entity Type:Individual
Prefix:
First Name:GRAY
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3455 RINGSBY CT STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-4923
Mailing Address - Country:US
Mailing Address - Phone:303-500-1518
Mailing Address - Fax:
Practice Address - Street 1:7200 GLEN FOREST DR STE 106
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3768
Practice Address - Country:US
Practice Address - Phone:804-495-0053
Practice Address - Fax:720-598-0440
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024176527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty