Provider Demographics
NPI:1013987452
Name:WRAY, ALAN B (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:B
Last Name:WRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2671
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2671
Mailing Address - Country:US
Mailing Address - Phone:208-523-4906
Mailing Address - Fax:208-523-2025
Practice Address - Street 1:3100 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7533
Practice Address - Country:US
Practice Address - Phone:208-227-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM50302085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010165236OtherREGENCE BLUE SHIELD OF IDAHO
ID002795600Medicaid
WA8418154Medicaid
P00206340OtherRAILROAD MEDICARE
ID000010150559OtherREGENCE BS OF IDAHO
ID1121800OtherMEDICARE PTAN
WA0192804OtherLABOR & INDUSTRIES
ID1121801OtherMEDICARE PTAN
IDB4133OtherBLUE CROSS OF IDAHO
P00206340OtherRAILROAD MEDICARE
IDA02425Medicare UPIN