Active NPI
Robert E Gray, PA-C
- Physician Assistant
- Saint Louis, MO
National Provider Identifier
1023148152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 102594
- Practice address
- 1 Barnes Jewish Hospital PLZ
Saint Louis, MO 63110-1003 - Phone
- (314) 454-8134
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 102594 | MO | Primary |
Addresses
Primary practice location
1 Barnes Jewish Hospital PLZ
Saint Louis, MO 63110-1003
Mailing address
1705 Big Horn Basin Dr
Wildwood, MO 63011-4821
Phone (636) 458-9065
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102594 | MO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023148152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1705 BIG HORN BASIN DR",
"city": "WILDWOOD",
"state": "MO",
"postal_code": "630114821",
"telephone_number": "636-458-9065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BARNES JEWISH HOSPITAL PLZ",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101003",
"telephone_number": "314-454-8134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "ROBERT",
"middle_name": "E",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MO",
"license": "102594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.