Provider Demographics
NPI:1851559884
Name:MADRAY, MONICA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:M
Last Name:MADRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SAN GABRIEL VILLAGE BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5594
Mailing Address - Country:US
Mailing Address - Phone:512-819-9910
Mailing Address - Fax:512-819-9970
Practice Address - Street 1:700 SAN GABRIEL VILLAGE BLVD
Practice Address - Street 2:STE 105
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5594
Practice Address - Country:US
Practice Address - Phone:512-819-9910
Practice Address - Fax:512-819-9970
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4566174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB103322Medicare PIN