Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP7742 | AZ |
NPI | 1013387778 |
---|---|
Provider Name | Anthony Bray |
First Address | Gilbert, AZ 85297-3519 |
Second Address | Minnetonka, MN 55343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2015 |
Last Update Date | 02/07/2020 |