Provider Demographics
NPI:1497289193
Name:WRAY, ADAM TAYLOR (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:TAYLOR
Last Name:WRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12842 S 3600 W STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6853
Mailing Address - Country:US
Mailing Address - Phone:801-913-6771
Mailing Address - Fax:
Practice Address - Street 1:12842 S 3600 W STE 200
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6853
Practice Address - Country:US
Practice Address - Phone:801-913-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT12165023-1204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program