Provider Demographics
NPI:1619998499
Name:GRAY, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2128
Mailing Address - Country:US
Mailing Address - Phone:763-561-5349
Mailing Address - Fax:
Practice Address - Street 1:6200 SHINGLE CREEK PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2128
Practice Address - Country:US
Practice Address - Phone:763-544-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32388207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN427392300Medicaid
MN3124729OtherMEDICA
MNHP13411OtherHEALTHPARTNERS
WI31709300Medicaid
MN103617C028OtherUCARE
MN33007OtherPREFERRED ONE
MNIM0129OtherAMERICA'S PPO
MN427392300Medicaid
MN33007OtherPREFERRED ONE
MN103617C028OtherUCARE