Johnathan Gray
Individual provider Active NPI Radiography Radiologic Technologist · Firestone, CO
NPI 1134536352 · NPPES record last updated Jul 21, 2014
Key facts
- NPI
- 1134536352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Radiography Radiologic Technologist 2471C3402X
- License
- 525624 (CO)
- Practice address
- 5834 Twilight Ave
Firestone, CO 80504-6486 - Phone
- (303) 775-7794
- NPI assigned
- Jul 21, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 525624 | CO | MD | Radiography Radiologic Technologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiography Radiologic Technologist | 2471C3402X | 525624 | CO | Yes |
Addresses
Primary practice location
5834 Twilight Ave
Firestone, CO 80504-6486
Mailing address
5834 Twilight Ave
Firestone, CO 80504-6486
Phone (303) 775-7794
Other providers in Firestone, CO
- Kirsten Garner
- Ryan Gebhardt
- Danielle Christen Geyer
- Kylee Goldsmith
- Goodwin Chiropractic a PLLC
- Brandilynn Greig
- H Lindsay Wright O.D., P.C.
- Ellen Marie Hand
- Annalise Hannah
- Hansen Eyecare PLLC
All providers in Firestone, CO · Radiography Radiologic Technologist in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.