Individual
TYLER BRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-6583
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 269-6583
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2017040033
MO
207P00000X
Emergency Medicine Physician
34.012018
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0122178
—
OH
05
—
1790191807
—
MO
05
—
200050802
—
MO
Enumeration date
07/09/2014
Last updated
12/27/2018
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