Active NPI
Roger Gray, PA-C
- Medical Physician Assistant
- Sun City Center, FL
National Provider Identifier
1245342385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 370
- Practice address
- 4031 Upper Creek Dr
Sun City Center, FL 33573-6819 - Phone
- (813) 633-2733
- Fax
- (813) 642-0367
- NPI assigned
- Aug 31, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 370 | WY | Primary |
| Medical Physician Assistant | 363AM0700X | PA9102593 | FL |
Addresses
Primary practice location
4031 Upper Creek Dr
Sun City Center, FL 33573-6819
Mailing address
4031 Upper Creek Dr
Sun City Center, FL 33573-6819
Phone (813) 633-2733
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 370 | WY | MD | Addiction (Substance Use Disorder) Counselor |
| PA9102593 | FL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glenrock Hospital District | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba glenrock health center
- Clinical Medical Laboratory
- Glenrock, WY
- NPI 1437294972
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222300800000",
"number": "1245342385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4031 UPPER CREEK DR",
"city": "SUN CITY CENTER",
"state": "FL",
"postal_code": "335736819",
"telephone_number": "813-633-2733",
"fax_number": "813-642-0367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4031 UPPER CREEK DR",
"city": "SUN CITY CENTER",
"state": "FL",
"postal_code": "335736819",
"telephone_number": "813-633-2733",
"fax_number": "813-642-0367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "ROGER",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2008-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WY",
"license": "370",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA9102593",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sun City Center, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.