Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | M2208 | TX |
NPI | 1407954217 |
---|---|
Provider Name | Curtis J. Wray |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 03/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177771601 | (05) | TX |
177771602 | (05) | TX |
8AN622 | BLUE CROSS BLUE SHIELD (01) | TX |
I39086 | (02) |