Provider Demographics
NPI:1932100914
Name:BRAY, KEVIN B (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:BRAY
Suffix:
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 1:1104 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3306
Mailing Address - Country:US
Mailing Address - Phone:605-665-7841
Mailing Address - Fax:605-665-0546
Practice Address - Street 1:1104 W 8TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3306
Practice Address - Country:US
Practice Address - Phone:605-665-7841
Practice Address - Fax:605-665-0546
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3686207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6200800Medicaid
SDS4105Medicare PIN
NE275381Medicare PIN
SDG11595Medicare UPIN