Individual
DR. ALAN B WRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 227-2600
Mailing address
PO BOX 2671, IDAHO FALLS, ID 83403-2671
(208) 523-4906
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M5030
ID
2085R0204X
Vascular & Interventional Radiology Physician
M5030
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010150559
REGENCE BS OF IDAHO
ID
01
—
000010165236
REGENCE BLUE SHIELD OF IDAHO
—
05
—
002795600
—
ID
01
—
0192804
LABOR & INDUSTRIES
WA
01
—
1121800
MEDICARE PTAN
ID
01
—
1121801
MEDICARE PTAN
ID
05
—
8418154
—
WA
01
—
B4133
BLUE CROSS OF IDAHO
ID
01
—
P00206340
RAILROAD MEDICARE
—
Enumeration date
01/26/2006
Last updated
08/08/2008
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