Provider Demographics
NPI:1861983421
Name:GRAY, IAN MICHAEL-FRANCIS
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:MICHAEL-FRANCIS
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 1:637 SPREADING OAK AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9003
Mailing Address - Country:US
Mailing Address - Phone:386-216-8547
Mailing Address - Fax:
Practice Address - Street 1:637 SPREADING OAK AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9003
Practice Address - Country:US
Practice Address - Phone:386-216-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician