Provider Demographics
NPI:1275818155
Name:GRAY, JASON (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:2230 N UNIVERSITY PKWY
Practice Address - Street 2:STE 9B
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1509
Practice Address - Country:US
Practice Address - Phone:801-375-3175
Practice Address - Fax:801-375-2818
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4985363AM0700X, 363AS0400X
UT10174240-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical