Individual
DR. MICHAEL DORAN WRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2621 GROVE AVE, RICHMOND, VA 23220-4308
(804) 254-5107
Mailing address
PO BOX 36559, RICHMOND, VA 23235-8011
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101033637
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16817
OPTIMAHEALTH
—
01
—
224104
ANTHEM-GROVE AVE.
VA
Enumeration date
07/29/2005
Last updated
08/10/2007
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