Provider Demographics
NPI:1750543146
Name:GRAY, JON ROGER (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:ROGER
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 TREYBURN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2891
Mailing Address - Country:US
Mailing Address - Phone:757-772-0192
Mailing Address - Fax:
Practice Address - Street 1:3901 TREYBURN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2891
Practice Address - Country:US
Practice Address - Phone:757-772-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012746392083X0100X
TN434992083X0100X
TNMD00000434992083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine