Doctor Name: | JOHNATHAN GRAY |
NPI Number: | 1134536352 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 525624 |
Business Practice Address: | 5834 Twilight Ave Firestone, CO - 805046486 |
Business Phone Number: | 3037757794 |
Business Fax Number: | |
Mailing Address: | 5834 Twilight Ave, FIRESTONE |
State: | CO |
Postal Code: | 805046486 |
Phone Number: | 3037757794 |
Fax Number: | |
NPI Enumeration Date: | 07/21/2014 |
NPI Last Update Date: | 07/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2471C3402X |
License Number: | 525624 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | Radiography |
Taxonomy Definition: |