Individual
BRIAN DAVID RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
400 S. BLAIRSFERRY CROSSING, SUITE A, HIAWATHA, IA 52233-7988
(319) 393-0783
(319) 393-0427
Mailing address
400 S. BLAIRSFERRY CROSSING, SUITE A, HIAWATHA, IA 52233-7988
(319) 393-0783
(319) 393-0427
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3734
IA
207Q00000X
Family Medicine Physician
R7651
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528029501
—
IA
01
—
P00708643
RR MEDICARE
IA
Enumeration date
03/30/2006
Last updated
11/01/2011
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