Individual
DR. ADAM WRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1355 PARKWAY DR STE A, BLACKFOOT, ID 83221-1656
(986) 275-0003
(986) 275-0005
Mailing address
1355 PARKWAY DR STE A, BLACKFOOT, ID 83221-1656
(986) 275-0003
(986) 275-0005
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
O-0444
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010163015
REGENCE BLUE SHIELD BLKFT
ID
01
—
000010163016
REGENCE BLUE SHIELD POC
ID
01
—
315520
ALTIUS
ID
05
—
807719000
—
ID
01
—
S6116
BLUE CROSS BLKFT
ID
01
—
S6117
BLUE CROSS POC
ID
Enumeration date
01/25/2007
Last updated
05/06/2026
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