Provider Demographics
NPI:1528359577
Name:FURNISS, MEGAN WRAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:WRAY
Last Name:FURNISS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 HELEN AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5627
Mailing Address - Country:US
Mailing Address - Phone:510-717-2552
Mailing Address - Fax:
Practice Address - Street 1:5144 HILL RD E
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6300
Practice Address - Country:US
Practice Address - Phone:707-263-8955
Practice Address - Fax:707-263-8340
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15566207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology