Provider Demographics
NPI:1588633499
Name:WRAY, MARY JANE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:WRAY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:WRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1390
Mailing Address - Country:US
Mailing Address - Phone:830-672-6511
Mailing Address - Fax:
Practice Address - Street 1:1602 HILL ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-2525
Practice Address - Country:US
Practice Address - Phone:512-772-4887
Practice Address - Fax:830-875-6398
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG47572080P0205X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0074KVOtherBCBS PROVIDER ID
TX137109801Medicaid
TX137109801Medicaid