Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 285642 | MA |
NPI | 1003346776 |
---|---|
Provider Name | Dr. Matthew Gray |
First Address | Springfield, MA 01199-1001 |
Second Address | Westfield, MA 01085-3678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2017 |
Last Update Date | 26/10/2020 |