Provider Demographics
NPI:1447012885
Name:GRAY, QUINTON ALEXANDER
Entity type:Individual
Prefix:
First Name:QUINTON
Middle Name:ALEXANDER
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 1:19704 X ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-4221
Mailing Address - Country:US
Mailing Address - Phone:531-329-7426
Mailing Address - Fax:
Practice Address - Street 1:19704 X ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-4221
Practice Address - Country:US
Practice Address - Phone:531-329-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide