Isaac Benjamin Gray
Physician Assistant in Edmond, OK. Individual provider (NPI-1).
NPI number1164063699
StatusActive
Last updated in NPPESApr 12, 2021
Details
- NPI
- 1164063699
- Entity type
- Individual (NPI-1)
- Name
- Isaac Benjamin Gray
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 6, 2019
- Certification date
- Apr 12, 2021
- Last updated
- Apr 12, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 4544 | OK | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | OK |
Practice location
2017 W I 35 Frontage Rd Ste 250Edmond, OK 73013-8561
Phone 405-757-3340 · Fax 405-757-3520
Mailing address
2017 W I 35 Frontage Rd Ste 250Edmond, OK 73013-8561
Phone 405-757-3340 · Fax 405-757-3520
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