Provider Demographics
NPI:1508952821
Name:GRAY, JAMES M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:GRAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 W MICH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068
Mailing Address - Country:US
Mailing Address - Phone:269-781-4700
Mailing Address - Fax:269-781-7168
Practice Address - Street 1:1170 W MICH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068
Practice Address - Country:US
Practice Address - Phone:269-781-4700
Practice Address - Fax:269-781-7168
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG001055213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2122030Medicaid
MI5135002Medicare ID - Type Unspecified
MI2122030Medicaid