Provider Demographics
NPI:1972099091
Name:GRAY, CORY MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:MATTHEW
Last Name:GRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PORTLAND ST STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7390
Mailing Address - Country:US
Mailing Address - Phone:573-886-4600
Mailing Address - Fax:573-886-4695
Practice Address - Street 1:300 PORTLAND ST STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7390
Practice Address - Country:US
Practice Address - Phone:573-886-4600
Practice Address - Fax:573-886-4695
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125071858207ZP0102X
MO2021018271207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology