Most Relevant Information
Provider Data
| NPI Number: | 1003504929 |
| Provider Name: | JOSHUA GRAY |
| Entity Type: | Individual |
| Taxonomy Code: | 261QP2000X |
| Specialty: | Clinic/Center |
| License Number: | PT5951 |
Most Important Dates
| Enumeration Date: | 04/27/2023 |
| Last Updated: | 04/27/2023 |
Provider Practice Location
758 BROADWAY
BANGOR
ME
044013224
Practice Location Phone/Fax
| Phone: | 2079418400 |
| Fax: |
Provider Mailing Location
324 MEDFORD RD
LAGRANGE
ME
044535214
Provider Mailing Phone/Fax
| Phone: | 2079436872 |
| Fax: |