Individual
JOHN B GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-0364
Mailing address
PO BOX 553, TWIN FALLS, ID 83303-0553
(208) 736-0887
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M-4393
ID
Other
Enumeration date
04/20/2006
Last updated
07/20/2020
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