Provider Demographics
NPI:1902903230
Name:GRAY, JAMES HAROLD JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HAROLD
Last Name:GRAY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1250
Mailing Address - Country:US
Mailing Address - Phone:419-542-6692
Mailing Address - Fax:
Practice Address - Street 1:107 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ANTWERP
Practice Address - State:OH
Practice Address - Zip Code:45813-8434
Practice Address - Country:US
Practice Address - Phone:419-542-5495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0572590Medicaid
OH0572590Medicaid
OH1891744843OtherGROUP NPI #
2113126OtherMEDICAID GROUP NUMBER