Provider Demographics
NPI:1861478778
Name:GRAY, PATRICK KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KEITH
Last Name:GRAY
Suffix:
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 1:3131 NEWMARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5400
Mailing Address - Country:US
Mailing Address - Phone:937-438-8910
Mailing Address - Fax:
Practice Address - Street 1:27100 CHARDON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1116
Practice Address - Country:US
Practice Address - Phone:440-585-6500
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007164G207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHN381410OtherWELLCARE
OH2233970Medicaid
OH000000269013OtherANTHEM
OHP00329871OtherRAILROAD MEDICARE
OHGR4058857Medicare PIN
OH930123609Medicare PIN
OHGR4058856Medicare PIN
OHGR4058852Medicare PIN
OH000000269013OtherANTHEM
OHP00329871OtherRAILROAD MEDICARE
OHN381410OtherWELLCARE