Provider Demographics
NPI:1053398982
Name:GRAY, MATTHEW N (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:N
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 5TH AVE SE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2464
Mailing Address - Country:US
Mailing Address - Phone:319-363-8121
Mailing Address - Fax:319-365-1396
Practice Address - Street 1:1030 5TH AVE SE
Practice Address - Street 2:SUITE 1400
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2464
Practice Address - Country:US
Practice Address - Phone:319-363-8121
Practice Address - Fax:319-365-1396
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1053398982Medicaid
IA3203034Medicaid
IA6203034Medicaid
IA2203034Medicaid
IA080180975OtherRR MEDICARE
IA4203034Medicaid
IA5203034Medicaid
IA2203034Medicaid
IA4203034Medicaid