Individual
MR. JON HARVEY GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 OAK PARK BLVD., LAKE CHARLES, LA 70601
(337) 494-3036
(337) 494-2181
Mailing address
6034 ST. CHARLES AVE, NEW ORLEANS, LA 70118
(504) 296-7959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
022139
LA
208D00000X
General Practice Physician
Primary
022139
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1668974
—
LA
05
—
66897
—
LA
Enumeration date
11/09/2005
Last updated
04/21/2020
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