Provider Demographics
NPI:1164410056
Name:BRAY-MORRIS, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:BRAY-MORRIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:455 SAINT MICHAELS DR
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7601
Mailing Address - Country:US
Mailing Address - Phone:505-820-5227
Mailing Address - Fax:
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-982-6241
Practice Address - Fax:505-982-6280
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM20030404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001R78OtherBCBS NM
202021218OtherPRESBYTERIAN HEALTH PLANS
NM75976021Medicaid
QMP000003397703OtherMOLINA
NMG87250Medicare UPIN
NM341327202Medicare ID - Type Unspecified
202021218OtherPRESBYTERIAN HEALTH PLANS