Individual
JENNIFER GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6533 W EMERALD STREET, BOISE, ID 83704
(208) 302-5200
(208) 302-5225
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-5200
(208) 302-5225
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7051
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003701700
—
ID
01
—
080186325
RRMCR
ID
Enumeration date
02/09/2007
Last updated
11/07/2018
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