Provider Demographics
NPI:1013940436
Name:WRAY, EVERETT B III (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:B
Last Name:WRAY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1249 15TH STREET
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-691-8500
Mailing Address - Fax:304-691-8510
Practice Address - Street 1:1249 15TH STREET
Practice Address - Street 2:SUITE 4000
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-691-8500
Practice Address - Fax:304-691-8510
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN34094207RC0000X
WV10053207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087197000Medicaid
A72616Medicare UPIN
TN38540051Medicare PIN