Provider Demographics
NPI:1558562496
Name:BRAY, MACEY (DO)
Entity Type:Individual
Prefix:DR
First Name:MACEY
Middle Name:
Last Name:BRAY
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:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-2019
Mailing Address - Country:US
Mailing Address - Phone:505-325-1572
Mailing Address - Fax:505-327-4887
Practice Address - Street 1:801 W MAPLE STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-272-0011
Practice Address - Fax:505-272-5821
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1541-102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology