Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G3983 | TX |
N | 207KA0200X | Allergist | G3983 | TX |
N | 2080P0201X | Pediatric Allergist | G3983 | TX |
N | 2080P0214X | Pediatric Pulmonologist | G3983 | TX |
NPI | 1669463899 |
---|---|
Provider Name | Dr. John David Bray |
First Address | Midland, TX 79701 |
Second Address | Midland, TX 79701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2005 |
Last Update Date | 14/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110211301 | (05) | TX |
C13727 | (02) |