Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D97841 | TX |
NPI | 1003812108 |
---|---|
Provider Name | Dr. Thomas James Wray |
First Address | Abilene, TX 79606-5270 |
Second Address | Abilene, TX 79606-5270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 20/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
085574401 | (05) | TX |
114791001 | (05) | TX |
127310100 | FIRST CARE (01) | TX |
84Z209 | BLUE CROSS BLUE SHIELD (01) | |
D97841 | (02) |