Provider Demographics
NPI:1336699032
Name:RAY, BRANDON M SR
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:RAY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 GRAND CANE LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-4879
Mailing Address - Country:US
Mailing Address - Phone:979-618-0331
Mailing Address - Fax:
Practice Address - Street 1:3306 GRAND CANE LN
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-4879
Practice Address - Country:US
Practice Address - Phone:979-618-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care