Individual
MR. MICHAEL RAY MABREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
702 N MAIN ST, OPP, AL 36467-1626
(334) 493-3541
(334) 493-9664
Mailing address
PO BOX 1010, OPP, AL 36467-1010
(334) 493-3541
(334) 493-9664
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-033536
AL
367500000X
Certified Registered Nurse Anesthetist
268206
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000026302
—
AL
01
—
051026302MAB
BCBS PROVICER NUMBER
AL
01
—
186VP/028G4
BCBS - CRNA ONLY
NC
01
—
PO1383957
MEDICARE RAILROAD
NC
01
—
Q47286C545
MEDICARE - CRNA ONLY
NC
Enumeration date
05/30/2006
Last updated
05/31/2016
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