Individual
JUSTIN WYLIE WRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1700 WEST AVE # 6, WACO, TX 76707-3054
(254) 399-0741
(254) 399-0779
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
TRN17315
FL
2085R0001X
Radiation Oncology Physician
Primary
R3455
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372654901
—
TX
05
—
372654902
—
TX
Enumeration date
05/29/2012
Last updated
06/20/2019
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