Provider Demographics
NPI:1235134453
Name:GRAY, SCOTT E (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PATTERSON RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1953
Mailing Address - Country:US
Mailing Address - Phone:970-298-2275
Mailing Address - Fax:970-298-7814
Practice Address - Street 1:425 PATTERSON RD
Practice Address - Street 2:SUITE 406
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1953
Practice Address - Country:US
Practice Address - Phone:970-298-2275
Practice Address - Fax:970-298-7814
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110344207VM0101X
CO46858207VM0101X
KS18720207VM0101X
NE19027207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64454274Medicaid
KS100271580HMedicaid
UT1235134453Medicaid
KS104359Medicare ID - Type Unspecified
UT1235134453Medicaid
CO64454274Medicaid
KS100271580HMedicaid