DR. JOHN D GRAY (NPI# 1639284623) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639284623 |
| Entity Type | Individual |
| Full Name | DR. JOHN D GRAY |
| Credential | MD |
| Practice Address |
1881 Chicago St Depere WI 54115 |
| Mailing Address |
3301 W Forest Home Ave Milwaukee WI 53215-2843 |
| Practice Telephone | 9204038000 |
| Practice Fax Number | 9204038202 |
| Mailing Telephone | 4146476326 |
| Mailing Fax Number | 4146718860 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 27644 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA NUMBER | AG1438515 | 01 | |
| WI | 30419400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346634086 | John Mitchell Gray | Counselor | 3216 E 1st St, Fort Worth, TX 76111-3831 | 2015-03-19 |
| 1720499106 | John Trent Gray | Counselor | 8733 Greenwood Ave N, Seattle, WA 98103-3661 | 2014-05-19 |
| 1649588237 | John Richard Gray Jr. | Pharmacist | 1125 E Hwy 80, Haughton, LA 71037-9430 | 2010-09-17 |
| 1174760813 | John T Gray | Hearing Instrument Specialist | 218 Island St, Chippewa Falls, WI 54729-2351 | 2009-01-16 |
| 1083736938 | John Alan Gray | Psychiatry & Neurology | 401 Parnassus, Box 0984-rtp, San Francisco, CA 94143-0984 | 2007-04-04 |
| 1497885990 | John William Gray IIi | Family Medicine | 116 Old Jericho Rd, Beaufort, SC 29902-5119 | 2007-03-06 |
| 1225060403 | John Gray | Family Medicine | 801 W Broad St, Bethlehem, PA 18018-5264 | 2006-07-07 |
| 1821028127 | John R. Gray | Optometrist | 113 Battlefield Mall, Springfield Eyecare, LLC, Springfield, MO 65804 | 2006-07-03 |
| 1588633028 | John Robert Gray Jr. | Family Medicine | 902 E Pine St, Tulsa, OK 74106-5928 | 2006-03-16 |
| 1518460153 | John Troy Gray II | Social Worker | 14 S Paint St, Chillicothe, OH 45601-3203 | 2018-03-09 |
| Street Address |
1881 CHICAGO ST |
| City | DEPERE |
| State | WI |
| Zip Code | 54115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215044573 | Ronald E Roup | Pediatrics | 1881 Chicago St, Depere, WI 54115 | 2006-08-24 |
| 1114034733 | Jennifer L Hoyer | Pediatrics | 1881 Chicago St, Depere, WI 54115 | 2006-08-23 |
| 1366451429 | Lawrence E Colassacco | Family Medicine | 1881 Chicago St, Depere, WI 54115 | 2006-08-07 |
| 1508874223 | Raymond G Bachhuber | Internal Medicine | 1881 Chicago St, Depere, WI 54115 | 2006-08-05 |
| 1902814635 | Ronald A Barnes | Family Medicine | 1881 Chicago St, Depere, WI 54115 | 2006-08-05 |
| 1184632747 | Indira P Andhole | Pediatrics | 1881 Chicago St, Depere, WI 54115 | 2006-08-03 |
| 1043228612 | Jesusa S Andres-palines | Internal Medicine | 1881 Chicago St, Depere, WI 54115 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871138073 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 723 Main Ave, Depere, WI 54115 | 2019-11-12 |
| 1568928083 | Stephanie J Towle | Speech-Language Pathologist | 200 S. 9th St, De Pere, WI 54115 | 2019-02-20 |
| 1164988499 | Maribel L Zoeller | Physical Therapy Assistant | 200 S. 9th Street, Depere, WI 54115 | 2019-02-12 |
| 1255897641 | Elizabeth Eberius | Acupuncturist | 3311 S. Packerland Drive, Suite A #20, De Pere, WI 54115 | 2019-02-11 |
| 1548750458 | Jordyn E Arndt | Physical Therapist | 1601 Lawrence Dr Ste 100, De Pere, WI 54115 | 2018-05-16 |
| 1588153514 | David Nowakowski | Registered Nurse | 158 Cavil Way, De Pere, WI 54115 | 2018-05-04 |
| 1457858557 | Rennes Assisted Living Corp. | Assisted Living Facility | 1150 Lois Street, Depere, WI 54115 | 2018-04-06 |
| 1518473966 | Kirsten Lynne Masrelian | Behavioral Analyst | 2073 Lawrence Dr, De Pere, WI 54115 | 2017-12-21 |
| 1285146050 | Sydney Marie Schultz | Physical Medicine & Rehabilitation | 200 S. Ninth Street, De Pere, WI 54115 | 2017-11-01 |
| 1134666514 | Nicole L Bickham | Psychologist | 416 George St Ste 108, De Pere, WI 54115 | 2017-01-24 |
| Find all providers in zip 54115 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366451429 | Lawrence E Colassacco | Family Medicine | 1881 Chicago St, Depere, WI 54115 | 2006-08-07 |
| 1902814635 | Ronald A Barnes | Family Medicine | 1881 Chicago St, Depere, WI 54115 | 2006-08-05 |
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|---|---|---|---|---|
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| 1275159998 | Beam Healthcare, Sc | Family Medicine | 25 W Main St Fl 5, Madison, WI 53703-3399 | 2020-06-18 |
| 1487283503 | Enitza Damaris George | Family Medicine | 1906 Brackett Ave, Eau Claire, WI 54701-5042 | 2020-04-02 |
| 1093341380 | Tia Marie Vaccaro | Family Medicine | 1275 Judd Rd, Oregon, WI 53575-2573 | 2020-03-18 |
| 1134753411 | Proactive Md Sc,p.a. | Family Medicine | Brakebush Health Center, N4993 6th Dr., Westfield, WI 53964 | 2020-02-26 |
| 1790323608 | Solidaritus Health Wisconsin Sc | Family Medicine | 1476 Blazing Star Blvd Ste 4, Altoona, WI 54720-4002 | 2019-12-11 |
| 1255974952 | Integrative Health Center of Central Wisconsin LLC | Family Medicine | 3205 E Washington Ave Ste A, Madison, WI 53704-4332 | 2019-10-25 |
| 1962969220 | Paladina Health, LLC | Family Medicine | Paladina Health Menomonee Falls, N84 W15787 Menomonee Avenue Suite 6, Menomonee Falls, WI 53051 | 2019-02-22 |
| 1942767298 | Paladina Health, LLC | Family Medicine | Paladina Health Sussex Beer Capitol Clinic, W222 N5700 Miller Way, Sussex, WI 53069 | 2019-02-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.