Provider Demographics
NPI:1821434424
Name:WRAY, ROBERT BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:WRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2665 E. PARLEYS WAY
Mailing Address - Street 2:#204
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1672
Mailing Address - Country:US
Mailing Address - Phone:801-433-4521
Mailing Address - Fax:801-433-4521
Practice Address - Street 1:2665 E. PARLEYS WAY
Practice Address - Street 2:#204
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1672
Practice Address - Country:US
Practice Address - Phone:801-433-4521
Practice Address - Fax:801-433-4521
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT149852-1205174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist