Individual
DR. MALLORY SMITH BRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
520 MARY ST STE 520, EVANSVILLE, IN 47710-1682
(812) 424-8231
(812) 435-8794
Mailing address
520 MARY ST, STE 520, EVANSVILLE, IN 47710-1682
(812) 424-8231
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01078495A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001090862
ANTHEM BC BS
—
01
—
01078495
INDIANA STATE LICENSE
IN
05
—
300003517
—
IN
05
—
7100478760
—
KY
Enumeration date
04/10/2012
Last updated
03/04/2024
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