1235113846 NPI number — DR. AARON GRAY D.C.

Table of content: DR. AARON GRAY D.C. (NPI 1235113846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235113846 NPI number — DR. AARON GRAY D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
AARON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235113846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1368 SILVER LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940-1952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-622-6778
Provider Business Mailing Address Fax Number:
321-622-5282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 INTERLACHEN RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940-1994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-622-6778
Provider Business Practice Location Address Fax Number:
321-622-5282
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301002999 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: CH 10396 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OF32150 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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