Individual
PAMELA N. GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
(573) 202-2470
Mailing address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2015006863
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
03/04/2015
Last updated
08/22/2019
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