Provider Demographics
NPI:1861855207
Name:GRAY, CHASE ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:ALEXANDER
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:RR 5 BOX 85
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:IL
Mailing Address - Zip Code:61437-9726
Mailing Address - Country:US
Mailing Address - Phone:319-759-5847
Mailing Address - Fax:
Practice Address - Street 1:3635 VISTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-577-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program