Provider Demographics
NPI:1710090899
Name:BRAY, MAURY III (MD)
Entity Type:Individual
Prefix:
First Name:MAURY
Middle Name:
Last Name:BRAY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5935
Mailing Address - Country:US
Mailing Address - Phone:256-593-7266
Mailing Address - Fax:256-840-9833
Practice Address - Street 1:704 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5935
Practice Address - Country:US
Practice Address - Phone:256-593-7266
Practice Address - Fax:256-840-9833
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7169207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000000943Medicare PIN
ALC71169Medicare UPIN