Provider Demographics
NPI:1003127218
Name:BRAY BROWN, REGINA BRAXTON (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:BRAXTON
Last Name:BRAY BROWN
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 1:60 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1186
Mailing Address - Country:US
Mailing Address - Phone:740-779-4100
Mailing Address - Fax:740-779-4149
Practice Address - Street 1:25 N. JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521
Practice Address - Country:US
Practice Address - Phone:910-897-6423
Practice Address - Fax:910-897-2540
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.122200207Q00000X
VA0116022791207Q00000X
NC2018-02329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine