Provider Demographics
NPI:1326218108
Name:GRAY, ZACH JAMES (MACOM,LAC)
Entity Type:Individual
Prefix:MR
First Name:ZACH
Middle Name:JAMES
Last Name:GRAY
Suffix:
Gender:M
Credentials:MACOM,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3643
Mailing Address - Country:US
Mailing Address - Phone:719-248-4820
Mailing Address - Fax:719-299-4701
Practice Address - Street 1:3312 COLFAX AVE.
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008
Practice Address - Country:US
Practice Address - Phone:719-248-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1156171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist