Organization
S. JEFF BRAY, DPM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. S JEFF BRAY DPM (PRESIDENT)
(208) 233-2100
Entity
Organization
Contact information
Practice address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Mailing address
2240 E CENTER ST, POCATELLO, ID 83201-2600
(208) 233-2100
(208) 233-3146
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P157
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010034464
BLUE SHIELD
ID
05
—
806125200
—
ID
01
—
DD9805
RAILROAD MEDICARE
—
01
—
P9364
BLUE CROSS
ID
Enumeration date
06/14/2007
Last updated
09/07/2021
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