Provider Demographics
NPI:1003037961
Name:BRAY, JANICE RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:RENEE
Last Name:BRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 JOHN PAUL JONES CIR # 9-2123
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2197
Mailing Address - Country:US
Mailing Address - Phone:757-953-7301
Mailing Address - Fax:757-953-7300
Practice Address - Street 1:620 JOHN PAUL JONES CIR # 9-212392
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-7301
Practice Address - Fax:757-953-7300
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27176202C00000X, 2084F0202X
KY399242084F0202X, 2084P0800X
TXQ28852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ2558OtherTEXAS MEDICAL BOARD
AZ27176OtherARIZONA BOARD OF MEDICINE