Individual
JASON GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPAS
Contact information
Practice address
2230 N UNIVERSITY PKWY, STE 9B, PROVO, UT 84604-1509
(801) 375-3175
(801) 375-2818
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10174240-1206
UT
363AM0700X
Medical Physician Assistant
4985
AZ
363AS0400X
Surgical Physician Assistant
4985
AZ
Other
Enumeration date
10/11/2011
Last updated
11/27/2023
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