Individual
DR. GINA VICK BRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
187 STATELINE RD E, SUITE 10, SOUTHAVEN, MS 38671-1704
(662) 342-5353
(662) 393-9753
Mailing address
PO BOX 1369, SOUTHAVEN, MS 38671-0014
(662) 342-5353
(662) 393-9753
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15380
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118418
—
MS
Enumeration date
07/07/2005
Last updated
04/14/2011
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