Provider Demographics
NPI:1770663759
Name:GRAY, JOHN MERLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MERLE
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 1:7713 CENTER BLVD SE STE 160
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-6309
Mailing Address - Country:US
Mailing Address - Phone:425-292-3347
Mailing Address - Fax:425-738-3020
Practice Address - Street 1:7713 CENTER BLVD SE STE 160
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-6309
Practice Address - Country:US
Practice Address - Phone:425-292-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F47201Medicare UPIN
G8896144Medicare PIN
F47201Medicare UPIN
8807817Medicare ID - Type Unspecified