Provider Demographics
NPI:1023413655
Name:GRAY, VERA GUMIELA (MMS PA-C)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:GUMIELA
Last Name:GRAY
Suffix:
Gender:F
Credentials:MMS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VILLAGE SQUARE XING STE 170
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4549
Mailing Address - Country:US
Mailing Address - Phone:561-627-8500
Mailing Address - Fax:844-959-0418
Practice Address - Street 1:900 VILLAGE SQUARE XING STE 170
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4549
Practice Address - Country:US
Practice Address - Phone:561-627-8500
Practice Address - Fax:844-959-0418
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108294363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical