Organization
SHANNON GRAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON GRAY (ADMINISTRATOR OWNER)
(480) 398-1228
Entity
Organization
Contact information
Practice address
605 N GILBERT RD, MESA, AZ 85203-6629
(480) 398-1220
(480) 398-1230
Mailing address
605 N GILBERT RD, MESA, AZ 85203-6629
(480) 398-1220
(480) 398-1230
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29241
AZ
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
06/08/2005
Last updated
12/29/2017
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