Provider Demographics
NPI:1861123929
Name:GRAY, TODD JAMES
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:JAMES
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5538 MILLER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651-2140
Mailing Address - Country:US
Mailing Address - Phone:319-269-8709
Mailing Address - Fax:
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-624-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical