Provider Demographics
NPI:1235234238
Name:GRAY, PAMELA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 4004
Mailing Address - Street 2:STUDENT HEALTH SERVICE UW EAU CLAIRE
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-4004
Mailing Address - Country:US
Mailing Address - Phone:715-836-4311
Mailing Address - Fax:715-836-5979
Practice Address - Street 1:UNIVERSITY OF WISCONSIN EAU CLAIRE STUDENT HEALTH SERV
Practice Address - Street 2:CREST WELLNESS CENTER
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-836-4311
Practice Address - Fax:715-836-5979
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI40454020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine