Individual
CHARLES P BRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2680 LEONARD ST NE STE 3, GRAND RAPIDS, MI 49525-6901
(616) 317-7246
(616) 920-6540
Mailing address
5555 GLENWOOD HILLS PKWY SE STE 2, GRAND RAPIDS, MI 49512-2091
(616) 940-2662
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001995
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P70026934
RAILROAD MEDICARE
—
Enumeration date
11/07/2005
Last updated
03/20/2024
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