Provider Demographics
NPI:1841247111
Name:MABREY, MICHAEL RAY (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:MABREY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1010
Mailing Address - Country:US
Mailing Address - Phone:334-493-3541
Mailing Address - Fax:334-493-9664
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1626
Practice Address - Country:US
Practice Address - Phone:334-493-3541
Practice Address - Fax:334-493-9664
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC268206367500000X
AL1-033536367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051026302MABOtherBCBS PROVICER NUMBER
AL000026302Medicaid
NCQ47286C545OtherMEDICARE - CRNA ONLY
NC186VP/028G4OtherBCBS - CRNA ONLY
NCPO1383957OtherMEDICARE RAILROAD
AL000026302Medicaid