Individual
PETER J GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1600 DELTA WATERS RD, SUITE 107, MEDFORD, OR 97504-9114
(541) 858-2515
(541) 858-2514
Mailing address
815 N CENTRAL AVE, SUITE C, MEDFORD, OR 97501-5873
(541) 734-9030
(541) 734-9885
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10003890
WA
363A00000X
Physician Assistant
Primary
PA154108
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010029019
REGENCE BLUE SHIELD OF ID
ID
01
—
149070
DEPT OF LABOR & INDUSTRIE
WA
01
—
19132
GROUP HEALTH NW
WA
01
—
2030GR
ASURIS NW HEALTH
WA
01
—
379109600
OWCP
WA
05
—
4310129
—
MT
05
—
805608100
—
ID
05
—
8387318
—
WA
01
—
8940235
CRIME VICTIMS
WA
01
—
970018798
RR MEDICARE
WA
01
—
KQ548
BLUE CROSS OF IDAHO
ID
01
—
PA154108
MEDICAL LICENSE
OR
Enumeration date
03/15/2006
Last updated
03/07/2023
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