| Dale Gray M.d.,s.c. | |
|
2720 Glenwood Ct Rockford IL 61101-3507 | |
| (815) 962-0633 | |
| (815) 962-0142 |
| Full Name | Dale Gray M.d.,s.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2720 Glenwood Ct, Rockford, Illinois |
| Authorized Official Name and Position | Dale Gray (PRESIDENT) |
| Authorized Official Contact | 8159620633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dale Gray M.d.,s.c. 2720 Glenwood Ct Rockford IL 61101-3507 Ph: (815) 962-0633 | Dale Gray M.d.,s.c. 2720 Glenwood Ct Rockford IL 61101-3507 Ph: (815) 962-0633 |
| NPI Number | 1750807558 |
|---|---|
| Provider Enumeration Date | 08/14/2017 |
| Last Update Date | 08/14/2017 |
| Medicare PECOS PAC ID | 2860751294 |
|---|---|
| Medicare Enrollment ID | O20180110002897 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750807558 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036072289 (Illinois) | Primary |
| Provider Name | Dale R Gray |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043252075 PECOS PAC ID: 9830155977 Enrollment ID: I20041209000570 |
| Provider Name | Jody Gosnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235687989 PECOS PAC ID: 6709173214 Enrollment ID: I20160928000145 |
| Provider Name | Jennifer Henrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942761390 PECOS PAC ID: 0244572733 Enrollment ID: I20190502002283 |
| Provider Name | Ashlee R Kramer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245936509 PECOS PAC ID: 4688049984 Enrollment ID: I20230418001359 |
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