Provider Demographics
NPI:1831222181
Name:BRAY, BETHANY C (MD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:C
Last Name:BRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-314-9760
Mailing Address - Fax:803-314-9761
Practice Address - Street 1:2728 SUNSET BLVD STE 106
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4836
Practice Address - Country:US
Practice Address - Phone:803-314-9760
Practice Address - Fax:803-314-9761
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27983207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC279834Medicaid
SCP00736329OtherRAILROAD ROAD MEDICARE PTAN
SCAA3702C362Medicare PIN
SC279834Medicaid
SCP00736329OtherRAILROAD ROAD MEDICARE PTAN
SCAA37022326Medicare PIN