Provider Demographics
NPI:1417537085
Name:GRAY, PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:184 SUMMIT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1960
Mailing Address - Country:US
Mailing Address - Phone:414-217-5421
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-1618
Practice Address - Fax:651-254-2410
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant