Provider Demographics
NPI:1972999431
Name:BRAY, BRADLEE JEROME (MS, CNIM)
Entity Type:Individual
Prefix:MR
First Name:BRADLEE
Middle Name:JEROME
Last Name:BRAY
Suffix:
Gender:M
Credentials:MS, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 BARREL DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9338
Mailing Address - Country:US
Mailing Address - Phone:252-412-6373
Mailing Address - Fax:
Practice Address - Street 1:435 BARREL DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9338
Practice Address - Country:US
Practice Address - Phone:252-412-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic