Provider Demographics
NPI:1831651447
Name:GRAY, ALAN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAMES
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:868 E RIVERSIDE DR STE 170
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6025
Mailing Address - Country:US
Mailing Address - Phone:208-918-2416
Mailing Address - Fax:208-203-8644
Practice Address - Street 1:868 E RIVERSIDE DR STE 170
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6025
Practice Address - Country:US
Practice Address - Phone:208-918-2416
Practice Address - Fax:208-203-8644
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID3271959207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery