| Mr Jon Harvey Gray, MD | |
|
1701 Oak Park Blvd., Lake Charles, LA 70601 | |
| (337) 494-3036 | |
| (337) 494-2181 |
| Full Name | Mr Jon Harvey Gray |
|---|---|
| Gender | Male |
| Speciality | General Practice |
| Location | 1701 Oak Park Blvd., Lake Charles, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356322077 | NPI | - | NPPES |
| 1668974 | Medicaid | LA | |
| 66897 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 022139 (Louisiana) | Secondary |
| 208D00000X | General Practice | 022139 (Louisiana) | Primary |
| Entity Name | Professional Emergency Medicine Management -- Lake Charles Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023430766 PECOS PAC ID: 7012131378 Enrollment ID: O20140609000077 |
| Entity Name | St Tammany Emergency Physicians Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1891187654 PECOS PAC ID: 7214255967 Enrollment ID: O20150409001843 |
| Entity Name | Thibodaux Emergency Physicians Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1568910503 PECOS PAC ID: 2769760537 Enrollment ID: O20161028001769 |
| Entity Name | Riverside Emergency Physician Partners Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083107080 PECOS PAC ID: 0042568917 Enrollment ID: O20180809000406 |
| Entity Name | Apex Medical Clinic |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962235374 PECOS PAC ID: 2466987466 Enrollment ID: O20241127003804 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Jon Harvey Gray, MD 6034 St. Charles Ave, New Orleans, LA 70118 Ph: (504) 296-7959 | Mr Jon Harvey Gray, MD 1701 Oak Park Blvd., Lake Charles, LA 70601 Ph: (337) 494-3036 |
Dr. Carl Wendell Ross Sr., MD General Practice Medicare: Medicare Enrolled Practice Location: 410 Louisiana Ave, Lake Charles, LA 70601 Phone: 337-439-4923 Fax: 337-439-4410 | |
Jake Thomas Hollen, M.D. General Practice Medicare: Not Enrolled in Medicare Practice Location: 4311 Suffolk St, Lake Charles, LA 70605 Phone: 337-477-9383 | |
Dr. Jerome J Arimura, M.D. General Practice Medicare: Not Enrolled in Medicare Practice Location: 1528 E. Prien Lake Rd., Ste. B, Lake Charles, LA 70601 Phone: 337-479-2057 Fax: 337-479-2099 |