Provider Demographics
NPI:1619103314
Name:GRAY, HEATHER M (DPM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2725
Mailing Address - Country:US
Mailing Address - Phone:419-225-2726
Mailing Address - Fax:419-228-9909
Practice Address - Street 1:1138 W HIGH ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2725
Practice Address - Country:US
Practice Address - Phone:419-225-2726
Practice Address - Fax:419-228-9909
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003578213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480031634OtherRAILROAD MEDICARE
CB6624OtherRAILROAD MEDICARE
OH2348856Medicaid
OHH094280Medicare UPIN
OH5374990001Medicare NSC
OH9314481Medicare PIN