Provider Demographics
NPI:1881670347
Name:BRAY, JEFFREY F (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:F
Last Name:BRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 162ND PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4916
Mailing Address - Country:US
Mailing Address - Phone:800-967-2299
Mailing Address - Fax:
Practice Address - Street 1:196 E 2000 N STE 101
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9335
Practice Address - Country:US
Practice Address - Phone:435-843-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039850207V00000X
UT14196420-1235207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1881670347Medicaid
UT1881670347Medicaid
NV1881670347Medicaid
WA8276693Medicaid
WA0158640OtherL&I