Provider Demographics
NPI:1144285065
Name:GRAY, CHRISTOPHER LEON (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEON
Last Name:GRAY
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9677 EAGLE RANCH RD NW
Mailing Address - Street 2:APT 116
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5854
Mailing Address - Country:US
Mailing Address - Phone:575-521-9246
Mailing Address - Fax:
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4495
Practice Address - Country:US
Practice Address - Phone:505-883-2574
Practice Address - Fax:505-265-4033
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2005-0025363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical