Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | NY005929 | NY |
N | 213ES0131X | Foot Surgery | NY005929 | NY |
Y | 213ES0131X | Foot Surgery | SC006975 | PA |
NPI | 1225094642 |
---|---|
Provider Name | Dr. Diane Bray |
First Address | Hershey, PA 17033-1310 |
Second Address | Hershey, PA 17033-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 13/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480032555 | RAILROAD MEDICARE (01) | NY |
U94954 | (02) | NY |