Provider Demographics
NPI:1558696328
Name:GRAY, PAMELA ANN (PA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:GRAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:255 TERRACINA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4881
Mailing Address - Country:US
Mailing Address - Phone:909-793-2500
Mailing Address - Fax:909-793-2502
Practice Address - Street 1:12065 OLD MERIDIAN ST STE 175
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8797
Practice Address - Country:US
Practice Address - Phone:317-818-5438
Practice Address - Fax:317-818-5444
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2023-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT002282363AM0700X
CA21036363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical